Objectives To compare the in-hospital outcomes of elderly patients with acute myocardial infarction (AMI) treated by interventional or conservative protocols. Patients and Methods One handred and seventy-six consec-utive patients hospitalized for AMI were involved, including 95 patients underwent emergent percutaneous coronary intervention (PCI) within 24 h after the onset of AMI and 81 patients received conservative non-invasive therapies. Clinical characteristics and in-hospital cardiac events of these two divisions were analyzed. Results In the PCI group, success rate of procedure and lesions was 98.9% and 98.5% , respectively. Procedure related complication were occurred in 6 cases(6.3%) and no patient died during operative procedures. PCI group had a lower in-hospi-tal mortality (11.6% vs 24.7 % , P < 0.05) and overall cardiac events rate (24.2 % vs56.8 % , P < 0.01) com-pared with conservative group. Patients complicated by pump failure at admission in PCI group had a lower mortality compared with their counterpart in conservative group(27.3% vs60.9%, P <0.05). The average hospital dura-tion between the two groups was no significant differences. The coronary care unit (CCU) duration of the PCI group was less than that of conservative group (4±5dvs8±5d, P < 0.05). Conclusions In elderly patients with AMI, interventional treatment can significantly decrease the in-hospital mortality and cardiac events rate compared with conservative treatment, thus gains a better short-term outcome.