Objective To investigate the clinical features and prognosis of percutaneous coronary intervention (PCI) for acute anterior ST-elevation myocardial infarction (STEMI) in the elderly patients. Methods Clinical data of 1 284 elderly STEMI patients with age ≥60 years who underwent PCI from Jan 2001 to Sep 2012 in our department were collected in this study. There were 643 cases of acute anterior myocardial infarction (the anterior group), and 641 cases with infarction at other parts of the heart (the control group). The incidence of major adverse cardiovascular events (MACE) was recorded and analyzed in both groups during their hospitalizations and 1-year follow-up. Results The percentage of the patients with cerebrovascular diseases, myocardial infarction and hypertension was significantly lower in the anterior group than in the control one (P＜0.05, P＜0.01). While the former group had higher percentages in proportion of males, KILLIP≥Ⅱ, and heart rate＞90 beats/min at admission than the latter one (P＜0.05 and P＜0.01). There was no significant difference in other clinical baseline information between the 2 groups (P＞0.05). In the application of angiotensin converting enzyme inhibitors, significantly more β-blockers, nitrates and diuretics were used in the anterior group than in the control one(P＜0.01). And the anterior group had a higher proportion of multi-vessel disease, a higher mean stent length and a higher average number of stents than the control group (P＜0.01). In 1 year after PCI, the cardiac mortality was obviously higher [6.8% (43/632) vs 3.5% (22/629), P＜0.01], and the rate of target vessel revascularization [4.7%(30/632) vs 9.4%(59/629), P＜0.01] was statistically lower in the anterior group than in the controls. The patients (≥75 years) had higher incidence of MACE than the other patients (＜75 years) [25.4% (30/118) vs 15.8% (81/514), P＜0.05]. Conclusion The elderly patients with acute anterior STEMI are more common in the males, with poor cardiac function, multivessel disease, severe illness, and more stents in PCI, but with a lower rate of long-term target vessel revascularization. The (≥75 years) patients have the higher incidence of MACE and poorer prognosis.