Objective To investigate the prognosis factors of postoperative cardiac complications in esophageal cancer patients co‐morbidated with coronary artery disease. Methods Clinical data of the patients with esophageal cancer surgery and concomitant coronary heart disease admitted to the esophageal surgery department of our hospital from December 2019 to June 2023 were collected. They were divided into two groups based on the occurrence of postoperative cardiac complications. Using postoperative cardiac complications as the dependent variable, we established a multivariate logistic regression analysis model to explore the relevant influencing. ResultsA total of 223 patients were collected, including 148 (70.71%) males and 75 (20.29%) females with an average of 71.78±6.31 years, ranging from 53 to 88 years. There were 71 (31.84%) patients experiencing at least one cardiac complication, including 2 patients of acute coronary syndrome, 13 patients of cardiac insufficiency, and 59 patients of new postoperative arrhythmias. The results of univariate analysis showed that age, systemic immune-inflammation index, pulmonary infection, respiratory failure requiring invasive ventilation, ARDS, acute delirium, additional drainage for pleural effusion, and acute renal insufficiency were risk factors for postoperative cardiac complications (P<0.05). The results of the multivariate logistic regression model showed that age (OR=1.062, 95%CI 1.008-1.120, P=0.024) and ARDS (OR=7.690, 95% CI 3.498-16.903, P<0.001) were independent risk factors for postoperative new cardiac complications in esophageal cancer patients with concomitant coronary heart disease. Conclusion Strengthening perioperative management of esophageal cancer, from strict preoperative evaluation to the treatment of postoperative complications, with particular attention to indicators such as age and ARDS, is crucial for improving the prognosis quality of patients with coronary heart disease complicated with esophageal cancer after surgery.