BACKGROUND: Females with acute myocardial infarction (AMI) have a higher risk of adverse outcomes because of receiving less evidence-based medical care. Our aim was to investigate the gender disparity in early death after ST-elevation myocardial infarction (STEMI) in the current era. METHODS: A total of 1429 consecutive patients with STEMI in the Liaoning district were analyzed. We compared hospital care and cardiac event data by sex for in-patients with acute STEMI within 24 hours of symptom onset. RESULTS: In the emergency reperfusion group (n=754), in-hospital mortality occurred in 4.2% of the males and 11.2% of the females (P=0.001). In the non-emergency reperfusion group (n=675), in-hospital mortality occurred in 13.0% of the males and 22.9% of the females (P=0.001). Multivariate Logistic regression analysis revealed female sex as an independent risk factor of death for STEMI patients during hospitalization (OR=1.691, P=0.007). After controlling for patients who died within 24 hr after admission, female sex was no longer an independent risk factor (OR=1.409, P=0.259). CONCLUSION: Female sex was an independent risk factor for in-hospital mortality of STEMI patients, which is explained by an excess of very early deaths.