Objective：To investigate the gender difference of direct percutaneous coronary intervention in patients with early-onset acute ST-segment elevation myocardial infarction（STEMI）. Methods：A total of 116 patients with early-onset acute STEMI who received direct PCI in the Department of Cardiovascular Medicine，Hebei General Hospital from September 01，2018 to December 31，2019 were selected as the study subjects，including 95 male patients and 21 female patients. The clinical data，surgical data，examination indicators and complications during hospitalization of 2 groups were collected and analyzed，and the differences were evaluated. Results：Compared with the male group，the female group was older，with higher score of GRACE and CRUSADE，higher ratio of type 2 diabetes，higher level of HDL-C and GLU，and higher risk of nosocomial adverse cardiovascular events （MACE），lower levels of hemoglobin，eGFR，and uric acid，and longer time from admission to balloon dilation （D2B time） and average length of hospital stay（ P<0.05）. The proportions of stent diameter and smoking history in male group were higher than those in female group （P<0.05）. Conclusion：Among patients with premature acute STEMI undergoing direct percutaneous coronary intervention，female patients were at higher risk of nosocomial adverse cardiovascular events and mortality.