Aim To explore the clinical characteristics and prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) who received drug conservative treatment. Methods The clinical data of 93 elderly patients with acute STEMI who received drug conservative treatment in our hospital from January 2013 to December 2016 were collected retrospectively. The basic clinical data, clinical medication and prognosis of patients were analyzed.The influencing factors of poor prognosis and death were analyzed by Logistic regression model. Kaplan-Meier curve was used to analyze the survival status of elderly patients over time. Results Most of the elderly STEMI patients had hypertension (64 cases, 68.8%) and hyperlipidemia (84 cases, 90.3%). In addition to aspirin and clopidogrel, the use rate of statins in elderly patients with acute STEMI was higher, and reached 89.2%. There were more patients with acute anterior wall myocardial infarction and acute inferior wall myocardial infarction, accounting for 41.9% and 28.0% respectively. The prognosis analysis showed that 33.3% of the patients had a good prognosis within two years, 32.3% of them died in hospital and 23.7% died out of hospital. Multivariate Logistic regression analysis showed that gender was the influencing factor for the poor prognosis of elderly patients with acute STEMI treated with conservative drugs (OR＝3.8,5%CI 1.09-9.26, P＝0.03), and the incidence of poor prognosis in female patients was 3.18 times that in male patients; NYHA cardiac function grade Ⅳ (OR＝67.7,5%CI 2.73-154.50, P＝0.01) and no diuretics using (OR＝0.6,5%CI 0.00-0.95, P＝0.04) were the risk factors of hospital death in elderly patients with acute STEMI. Conclusions In the elderly patients with acute STEMI receiving drug conservative treatment, the prognosis of women is often worse than that of men. NYHA cardiac function grade Ⅳ and no diuretics using are the risk factors of hospital death in elderly patients with acute STEMI.