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Introduction and Objectives: Mortality and morbidity after ST-elevation myocardial infarction (STEMI) are higher in women than men. It is not clear whether reperfusion by elective treatment with primary angioplasty can improve the poor prognosis in women with this condition. The objective of this study was to determine the effect of sex on clinical characteristics, and on in-hospital and long-term outcomes in patients with STEMI undergoing reperfusion by primary angioplasty., Methods: A prospective observational study was performed in 838 consecutive patients with STEMI treated by primary angioplasty at a single hospital. Of these, 183 (22%) were women., Results: Women were older (70 years vs 62 years; P<.01), were less frequently smokers (8% vs 53%; P<.01), more frequently had diabetes (45% vs 27%; P<.01) or hypertension (59% vs 36%; P<.01), presented later for angioplasty (4.1 h vs 3.6 h; P=.05), and experienced cardiogenic shock more frequently during the procedure (21% vs 12%; P<.01). There were no differences in the culprit vessel most often responsible for the infarction, in the procedural success rate, or in stent or glycoprotein IIb/IIIa inhibitor use. The total in-hospital mortality rate was higher in women (22% vs 9%; P<.01), as was the adjusted in-hospital rate (odds ratio 2.5, 95% confidence interval 1.2-5.2). During long-term follow-up after discharge (median 35.4 months), there was no significant difference in age-adjusted survival rate (relative risk 1.2, 95% confidence interval 0.7-1.9)., Conclusions: Despite recent advances in the treatment of STEMI, women experience greater in-hospital mortality, even after adjustment for baseline clinical characteristics. However, the long-term age-adjusted mortality rate in women discharged from hospital was similar to that in men.