Aim The effects of thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) for ST‐elevation myocardial infarction (STEMI) have been evaluated in several studies. The aim of the present study was to evaluate postprocedural outcomes in elderly STEMI patients who have a tendency for vasoconstruction and decreased coronary flow reserve. Methods A total of 124 patients (aged ≥65 years) with STEMI who underwent primary PCI (71.2% men, 29.8% women, mean age 74 ± 7 years) were enrolled in the study. Patients were divided into two groups according to intervention with and without TA. Acute angiographic, electrocardiographic and echocardiographic results were compared between the two groups. Results TA was carried out in 42 patients (33.8%). Baseline clinical characteristics and predischarge echocardiographic features did not differ between TA(+) and TA(–) patients (ejection fraction 37.26 ± 8.91 vs 38.53 ± 11.18, P = 0.558, wall motion index 1.69 ± 0.38 vs 1.76 ± 0.37, P = 0.316, septal E′ 0.058 ± 0.022 vs 0.053 ± 0.015, P = 0.267, E/E′ 11.82 ± 4.30 vs 13.12 ± 5.09, P = 0.370). Acute angiographic and electrocardiographic results did not differ between the two groups, but were slightly better in the thrombectomy group than those without TA corrected TIMI frame count (31.63 ± 16.33 vs 34.97 ± 15.81, P = 0.197, TIMI‐3 88.1% vs 79.3%, P = 0.223, ST segment resolution 81.3% vs 70.3%, P = 0.250). Conclusions Thrombectomy during primary PCI has no effect on postprocedural outcomes in an elderly group with STEMI. Geriatr Gerontol Int 2015; ●●: ●●–●●.