Objective To explore the clinical features and coronary lesion characteristics in the elderly female patients diagnosed as acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods A retrospective study was conducted on 366 consecutive female patients who were first diagnosed as acute STEMI and underwent primary PCI in our hospital from 2006 to 2012. The patients were divided into the aged group (≥65 years old, n＝211) and the non-aged group (＜65 years old, n＝155). The clinical features and coronary lesion characteristics of the 2 groups were analyzed. Results Compared with the non-aged group, the aged group had significantly higher incidence of diabetes, higher fasting blood glucose, lower percentage of smokers, lower glomerular filtration rate, larger amount of triple-vessel disease, and less involved lesions in the left anterior descending branch (LAD) (all P＜0.05). The success rates of PCI in the aged group and the non-aged group were 98.58% and 98.87%, respectively. Conclusion Female STEMI patients have different characteristics in risk factors among different ages. The aged female elderly patients have more complicated coronary lesions than the non-aged ones.