Aim To investigate the effect of thrombus aspiration in the elderly patients with acute ST-segment elevation myocardial infarction （STEMI） during the direct percutaneous coronary intervention （PCI）. Methods A total of 108 consecutive acute STEMI elderly patients （60-75 years years old） received PCI in the Frist People's Hospilal of Jingmen enrolled in this study from January 2011 to December 2013. These patients were divided into 2 groups: control group （n＝68） who underwent only PCI operation,and combined group （n＝40） who underwent thrombus aspiration combined PCI. The basic data,immediate postoperative coronary angiography,postoperative corrected TIMI frame count （CTFC）,hospitalization,and follow-up of 6 months after discharge were compared between the two groups. Results （1）The baseline data were identical and comparable in the two groups. （2）Compared with the control group,postoperative thrombolysis in myocardial infarction （TIMI） grade,rate of TIMI 3 and ST segment down back ＞50% ratio at postoperative 90 minutes were significantly higher,but rate of no-reflow and CTFC were significantly lower in the combined group （P<0.05）. There was no significant difference in mortality during hospitalization between the two groups （P>0.05）. （3）After follow-up 6 months,there were no statistical differences in total mortality,main adverse cardiac event （MACE） and rehospitalization rate for angina pectoris between the two groups （P>0.05）. Left ventricular ejection fraction （LVEF） of combined group was higher than that of control group （P<0.05）. Conclusions Thrombus aspiration can effectively reduce thrombus burden in coronary artery for elderly patients with acute STEMI. It can markedly improve microcirculation perfusion of myocardial tissue and cardiac function after PCI operation.