Objectives: The influence of admission source (nursing home [NH] versus community-dwelling) on treatment strategies and outcomes among elderly patients with ST-elevation myocardial infarction (STEMI) has not been investigated. Participants: Nationwide Inpatient Sample databases from 2003 to 2010 were used to identify 270,117 community-dwelling and 4082 NH patients 75 years of age or older with STEMI. Design: Retrospective observational study. Measurements: Propensity scores for admission source were used to assemble a matched cohort of 3081 community-dwelling and 3132 NH patients, who were balanced on baseline demographic and clinical characteristics. Bivariate logistic regression models were then used to determine the associations of NH with in-hospital outcomes among matched patients. Results: In-hospital mortality was significantly higher in patients with STEMI presenting from a NH as compared with community-dwelling patients (30.5% versus 27.6%; odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03-1.29; P= .012). Overall, NH patients were less likely to receive reperfusion (thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting) (11.5% versus 13.4%; OR0.84, 95% CI 0.72-0.98; P= .022). However, rates of percutaneous coronary intervention alone weresimilar in both groups (9.9% in NH versus 9.1% in community-dwelling; OR 1.10, 95% CI 0.93-1.30; P= .276). Mean length of stay was also similar in both groups (5.68 ± 5.40 days in NH versus 5.69 ± 4.98 days in community-dwelling, P= .974). Conclusion: Compared with their community-dwelling counterparts, older NH patients are less likely to receive reperfusion therapy for STEMI and have higher in-hospital mortality. © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.