Objective To assess the efficacy and safety of combined application of tirofiban with percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS) patients at different ages in perioperative period. Methods A retrospective study was carried out for consecutive ACS patients receiving low-dose tirofiban in perioperative period and undergoing PCI and drug-eluting stents (DES) implantation in our department from Jan. 2011 to Dec. 2012. A total of 302 patients (207 males and 95 females) were recruited in this study, and were divided into 2 groups according to their ages: the elderly group (≥65 years, n＝155) and the young and middle aged group(age＜65 years, n＝147). The incidences of primary and secondary end points of a major cardiovascular event were compared between the 2 groups within 30 d after the PCI. Multiple logistic regression analysis was used to analyze the risk factors for the endpoints. Results (1) Among the 302 patients, the incidence of primary end points was significantly higher in the elderly group than in the young and middle aged group [26(16.7%) vs 7(4.8%), P＝0.001]. (2) No serious acute intracranial bleeding occurred in the 2 groups. Each group had 1 case of gastrointestinal bleeding [1(0.7%) vs 1(0.6%), P＝1.000]. While, there were 24 patients (15.5%) having minimal bleeding events from the elderly group and 6 patients (4.2%) from the young and middle aged group (P＝0. 001). (3) Multiple logistic regression analysis indicated that aged over 65 years, female, history of smoking, diabetes mellitus, hyperlipidemia, and prior history of PCI were the independent risk factors of the primary end points in both groups during the 30-day follow-up. (4) Female, history of smoking, and diabetes mellitus were positively correlated with bleeding complications, while aging, hyperlipidemia, and prior history of PCI were not the independent predictive factors of bleeding events. Conclusion Combined application of tirofiban in perioperative period of PCI results in significant increases in the incidences of primary end points and minimal bleeding events in the elderly than in the young and middle aged patients, which suggests that the antiplatelet medication of tirofiban should be prudently conducted for the elderly.