Introduction: Coronary artery disease (CAD) in older adults ≥80 years of age is very common and a major cause of morbidity and mortality. Invasive management such as percutaneous coronary intervention (PCI) is sometimes held based on the prediction of poor prognosis, functionality, or advanced comorbidity. Methods: Here, we examined the Nationwide Inpatient Sample (NIS) data for baseline characteristics and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) for elderly patients with and without PCI. Results: Out of 416195 patients over the age ≥80 of years with primary diagnosis of STEMI, only 39220 (42.3%) underwent PCI. Half of those patients were female (50.7% versus 49.3 %, p<0.001). Patients with baseline characteristics of congestive heart failure (CHF), and renal failure (RF), metastatic cancer disease were less likely to undergo PCI (44.1 % versus 34.2%, 32.7% versus 26.1%, 11.53% versus 9.12%, p< 0.001) respectively. Inpatient hospital mortality for STEMI group without PCI intervention was twice as much compared to those who underwent PCI (45.4% versus 27.6%). Mean length of stay was slightly higher in STEMI patients without PCI (4.44 versus 4.38, p<.0001), while total hospital charges were higher in the PCI group ($114830 ±98516 versus $86131 ±110993, p <.0001). Moderate to severe disability was associated with less PCI intervention (35.5% versus 22.1%, p< 0.001). Furthermore, based on All Patient Refined DRGs (APR-DRG) severity scale, patients with severe loss of function were less likely to be selected for PCI 32.4% versus25.6%, p< 0.001) Conclusions: Advanced age was associated with poorer hospital outcomes in STEMI patients without PCI. Disability severity and APRDRG severity scale were associated with decision not to perform PCI. Older patients with baseline comorbidities of CHF, RF, and metastatic disease were also less likely to undergo PCI after STEMI.