Objective To investigate the safety and efficacy of emergency percutaneous coronary intervention (PCI) in the very elderly with acute coronary syndrome (ACS). Methods A total of 37 patients (≥80 years) who were diagnosed as ACS after admission in our department from January 2009 to June 2012 were subjected in this study. They were divided into two groups according to undergoing emergency PCI or not: PCI (n＝16) and control (n＝21) groups. The general clinical conditions and the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) in hospitalization duration and during the 30 days follow-up were compared between the two groups. Results No significant difference was seen with respect to baseline characteristics. Coronary arteriography indicated that more than 50% patients had lesions of chronic total occlusion, all patients of this group underwent PCI with drug eluting stenting. During hospitalization, the incidences of MACCEs including all-cause death, heart failure and nonfatal bleeding in PCI and control groups was 37.50% and 28.57%, respectively(P＝0.682). In 30 days follow-up, there was also no significant difference in the incidences of MACCEs between the two groups (15.79% vs 13.33%, P＝0.578), including death and rehospitalization due to heart failure or upper gastrointestinal hemorrhage. Conclusion For the very elderly with ACS, PCI with stenting is safe and efficient, and does not increase MACCEs incidence. Furthermore, the choice of stent should be individualized.