Elderly patients constitute a growing part of the ST segment elevation myocardial infarction (STEMI) popula-tion. By nature of their co-morbid conditions and other factors, elderly patients have a higher absolute rate of mortality and risk of complications from STEMI. It is for this very reason that rapid and complete optimal reperfu-sion therapy is essential. Unfortunately, little research has focused exclusively on elderly STEMI patients, and therefore what defines optimal reperfusion therapy in eld-erly patients is unclear. On the contrary, randomized clinical trials often specifically exclude patients older than age 75 because of their increased risk for complica-tions. The increased absolute rate of mortality and com-plications is precisely what often prevents physicians from attempting early, aggressive management of patients.