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Background: The population of the western world is rapidly ageing. 16% of deaths in the elderly are attributed to coronary artery disease. 69% of 30 day mortality following AMI in England is in the over 65s. As the population ages we can expect to see an increasing frequency of elderly patients presenting with ST elevation myocardial infarction (STEMI). We aim to compare long-term clinical outcomes in patients over 80 years with ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) with patients less than 80 years.Search methods: This was an observational cohort study of 10,249 consecutive patients with STEMI treated with PPCI between 2005 and 2011 at 8 tertiary centres across London, UK. The primary end-point was all-cause mortality. Median follow-up was 3 years.Results: A total of 1051 octogenarians (10.3%) were treated with primary PCI. Octogenarian STEMI patients had a higher prevalence of cardiovascular risk factors. They were also more likely to have worse left ventricular systolic function (20.6% vs 15.1%, p = 0.007) and cardiogenic shock (7.9% vs 5.7%, p = 0.004). Mortality over the follow-up period was higher in the octogenarian group compared to the younger group (51.6% vs 12.8%, p < 0.0001). However octogenarians were less likely to undergo radial access (HR:0.82 (0.65–0.94)), and receive adjunctive therapies e.g. GPIIb/IIIa inhibitors (HR:0.60 (0.45–0.82), all of which were demonstrated to have a survival benefit in the octogenarian group.Conclusions: This data is consistent with previous evidence that 69% of 30 day mortality following AMI in England is in the elderly. Mortality benefit is demonstrated with use of adjunctive therapies, routinely used in the younger age group, suggesting the use of these therapies should be promoted in the older population. [ABSTRACT FROM PUBLISHER]