There is scarce information about gender differences in clinical characteristics and the treatment of patients with ST-elevation myocardial infarction (STEMI). Objectives: The aim of this study was to assess gender differences regarding risk factors and hospital treatment of STEMI patients in different age groups. Design and Methods: This study included 655 consecutive unselected patients with STEMI from Estonian Myocardial Infarction Registry, who were admitted to the Tartu University Clinics between January 1, 2001 and December 31, 2003. Patients transferred from other hospitals were excluded. The patients were stratified into two age groups: <75 years and ≥75 years. Results: In comparison with male patients, female patients presented diabetes, hypertension and prior chronic heart failure more often (p < 0.05). There was no gender difference in the usage of evidence-based medications in both age groups, except for ACE-inhibitors. More frequent treatment with ACE-inhibitors in females (p < 0.05) might mainly be explained by a particular risk profile in this group. Older female patients were less frequently treated with thrombolysis than older male patients and no primary percutaneous coronary intervention (PCI) was performed for revascularization in this group either. Conclusion: This study points towards the need to re-estimate reperfusion therapy of elderly females ≥75 years old with STEMI in our hospital. Most probably, primary PCI as an effective and safe strategy of revascularisation could be proposed for elderly females who have frequently elevated blood pressure and, therefore, are more prone to intracranial haemorrhage related to thrombolysis.