Abstract: We aimed to assess imprints of obesity on elderly patients post-primary PCI concerning early outcomes. Methods: This is retrospective study with a total of 1187 patients above 60 years old who underwent primary PCI identified between 2015 and 2020 and were divided into three groups according to their BMI. The study included a subgroup of 69 extreme elderly patients above 80 years old who had been further subdivided into 3 groups consistent with their BMI Results: Obese elderly group included 26% (n=311) .Obese elderly patients were more in need of thrombus aspiration during coronary angiography but no significant difference was found amongst groups about multivessel and left main coronary diseases.The prevalence of severe myocardial dysfunction post-primary PCI was lower in obese in comparison to overweight and non-obese group. We found numerical but statistically non-significant lower in-hospital mortality in obese elderly patients in the unadjusted analysis compared to the non-obese group (4% vs. 5% vs 5%, p=0.6). Yet in-hospital stay was prolonged for obese patients in the other 2 groups. BMI is not an independent predictor of in-hospital death among the elderly post-primary PCI. Extreme age obese patients were more smokers with higher hemoglobin levels on discharge and higher left ventricular ejection fraction as less presented by anterior wall 2 MI, less in need for tirofiban use but no significant difference was estimated between groups regarding in-hospital mortality. Conclusion: obesity paradox is still significantly appearing in elderly. Although BMI is not a predictor of mortality in this age group obesity increases the in-hospital stay with an increasing burden on the health system.