Objective To study the efficacy of bivalirudine in emergency percutaneous coronary intervention (PCI) in the elderly patients with acute myocardial infarction. Methods Enrolled in the study were a total of 124 ST-elevation myocardial infarction (STEMI) patients who underwent PCI in Wuhan Asian Heart Hospital from April 2017 to December 2018. They were randomized into the study group and the control group, with 62 in each group.The two groups were given the same dose of aspirin and clopidogrel orally before operation, and the patients in the control group were given heparin intravenously and the patients in the study group bivalirudin during the operation. The two groups were compared in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), B-type natriuretic peptide (BNP), bleeding events and major adverse cardiovascular events (MACEs) during hospitalization, 30d and 60d after operation. SPSS statistics 18.0 was used for data analysis.Depending on the data type,t test or Chi-square test was used for comparison between groups. Results The two groups had no significant difference in preoperative LVEF, LVEDD and BNP (P>0.05). Compared with pre-operative levels, LVEF increased and LVEDD and BNP decreased at 30d after operation in both groups. Compared with the control group, the LVEF [(46.9±4.7)% vs (43.1±4.5)%] and BNP [(182.8± 83.4) vs (294.5±107.6)ng/L] improved significantly in the study group (P<0.05). Before operation, mild hemorrhage was observed in 1 patient in the study group and 1 patient in the control group, and 1 had moderate/severe hemorrhage in the control group. The difference was not statistically significant (P>0.05). At postoperative 30d, the incidence of hemorrhage in the study group was significantly lower than that in the control group[3.23%(2/62) vs 6.45%(4/62)]. The difference was statistically significant(χ²= 5.145; P<0.05). Therewas no significant difference in the incidence of MACEs[1.61%(1/62) vs 3.23%(2/62); 3.23%(2/62) vs 4.84%(3/62)]between the study group and the control group (χ²＝1.290,χ²＝0.112; P＞0.05). Conclusion Bivalirudine can improve cardiac functions in the patients with acute myocardial infarction undergoing PCI and significantly reduce the incidence of hemorrhage after PCI.