Background:Age, frailty, unusual presentation, undetected or subclinical vascular disease, socioeconomic problems, and psychological problems can all contribute to the higher prevalence and severity of coronary artery disease, which is linked to higher mortality and morbidity in older individuals. The present study was conducted to assess primary percutaneous coronary intervention in elderly patients with acute myocardial infarction.Materials & Methods:86 elderly patients (aged ≥65 years) who underwent primary angioplasty for acute STEMI of both genders were categorized into three types based on ACC/AHA classification such as type A lesions, type B and type C lesions. Parameters such as post procedure thrombolysis in myocardial infarction (TIMI) flow grades, ACC/AHA lesion classification, vessels treated, and mortality rate was recorded.Results:Out of 86 patients, 50 were males and 36 were females. Lesion type was bifurcation in 5, CTO in 7, calcified in 28, Ostia in 4, restenosis in 8 and other in 34. ACC/AHA lesion was type A in 40, B1 in 10, B2 in 29 and C in 7 cases. TIMI flow pre-procedure 0 was seen in 42, 1 in 29, 2 in 11 and 3 in 4 patients. TIMI flow post-procedure 0 was seen in 1, 1 in 5, 2 in 4 and 3 in 76. Procedural approach was right femoral in 50, left radial in 25 and left radial/right femora in 11. Vessels treated were RCA in 26, LAD in 28, LCx in 12, LAD and LCx in 5, LAD and RCA in 6, RCA and LCx in 3 and others (OM, Diagonal, PLV or PDA) in 9 cases. The difference was significant (P< 0.05). All cause mortality at 1 month was seen in 6, at 6 months in 8 and at 12 months in 10 cases. Cardiac death in 4, 6 and 9 cases at 1 month, 6 months and 12 months respectively. Non- cardiac death was seen in 2 at 6 months and 5 in 12 months respectively. The difference was significant (P< 0.05).Conclusion: Due to their decreased risks of MACE and stroke, older patients receiving primary PCI for AMI should be treated as the first line of treatment for this high-risk cohort.