Objective To compare the outcomes between direct percutaneous coronary intervention (PCI) and PCI after intravenous thrombolysis in the elderly patients suffering from acute ST-segment elevation myocardial infarction (STEMI). Methods Fifty-three elderly patients with STEMI occurring within 12h and without any contraindications of thrombolysis hospitalized in our department during October 2011 and January 2012 were enrolled into this study and retrospectively analyzed. They were divided into 2 groups according to the intervention they received, that is, thrombolysis＋PCI group (group A, n＝23) and direct PCI group (group B, n＝30). The clinical outcomes were compared between the 2 groups. Results The percentage of Thrombolysis in Myocardial Infarction (TIMI) flow at grades 2 to 3 in infarction related artery (IRA) was 69.6% in group A (16 cases), which was significantly higher than that in group B (14.3%, 4 cases, P＜0.01). There was no significant difference in the successful rate of stent implantation in infarction related artery (IRA) between the 2 groups (82.6% vs 90.0%, P＝0.431). No severe hemorrhage complication was observed in both groups during the hospitalization. Left ventricular ejection fraction (LVEF) after intervention was significantly higher in group A than in group B [(56.8±1.12)% vs (51.7±1.00)%, P＝0.001]. Conclusion When compared with direct PCI, intravenous thrombolysis combined with PCI has the advantages of higher rate of early recanalization of IRA but not increasing related hemorrhage risk in the treatment of the elderly STEMI patients, and exerts certain effects on the restoration of blood flow in IRA as early as possible and on the protection of contractile function of left ventricule.