Objective To explore the clinical diagnostic value of serum bilirubin and uric acid detection in patients with coronary heart disease. Methods A total of 100 patients with coronary heart disease from June 2020 to June 2021 were selected as the observation group, and another 100 healthy subjects in the same period were selected as control group. Serum bilirubin and uric acid levels were detected and compared between the two groups. Meanwhile, the patients in the observation group were divided into groups A, B, C and D according to the degree of coronary artery stenosis (Gensini method). The changes of the above indexes were compared among different grades of coronary stenosis. And the diagnostic efficacy of each single detection and combined detection of serum bilirubin and uric acid in patients with coronary heart disease were evaluated and compared. Results Compared with the control group, the serum bilirubin (total bilirubin, direct bilirubin, indirect bilirubin) level of the observation group was lower, and the uric acid level was higher, with statistical differences (P<0.05). With the increased severity of coronary artery stenosis, the serum bilirubin level of patients showed a downward trend, while the uric acid level showed an upward trend, and there were significant differences among the four groups (P<0.05). The sensitivity and specificity of serum bilirubin combined with uric acid detection in patients with coronary heart disease were 96.00% and 95.00% respectively, which were higher than those of single detection (P<0.05). Conclusions Serum bilirubin and uric acid levels can be used as sensitive indicators in the diagnosis of patients with coronary heart disease, and are closely related to the occurrence and development of coronary heart disease, which can reflect the severity of the disease, also the diagnostic value of combined detection is higher.