Aim Limited data are available on the safety and outcome of percutaneous coronary intervention (PCI) in elderly patients with ST elevation myocardial infarction (STEMI), as elderly patients are under‐represented in randomized trials. Methods We therefore aimed at assessing the trends in mortality rates (both at short‐term and at 1‐year follow up) in an unselected cohort of 404 STEMI patients aged ≥75 years all submitted to primary PCI and consecutively admitted to our Intensive Cardiac Care Unit from 2004 to 2010. Results In the first period (2004–2006), 202 patients (202/661, 30.6%) were aged ≥75 years, whereas in the second period (2007–2010), 203 patients (203/607, 33.4%) were aged ≥75 years. In the second period, STEMI patients were older (P < 0.001), more diabetic (P < 0.001) and with a higher incidence of comorbidities (P < 0.001). A significantly lower use of intra‐aortic balloon pump was observed, together with a reduced rate of bleeding, whereas the incidence of worsening renal function significantly increased (P = 0.011). No difference was observed in the length of stay and in mortality rate (both in‐hospital and 1‐year post‐discharge) between the first and the second period. Conclusions According to our data, patients aged ≥75 years are characterized by an increasing number of comorbidities (in particular, a higher incidence of diabetes). Over a 6‐year period, despite a more advanced age, early mortality (and length of stay) remained unchanged (probably thanks to a significant reduction in bleeding events), and no difference was observed in 1‐year post‐discharge mortality in these patients. Geriatr Gerontol Int 2013; 13: 711–717.