OBJECTIVE Patients with acute myocardial infarction (AMI) with unprotected left main coronary artery (ULMCA) as culprit lesion are a high-risk subgroup with a substantial mortality. Percutaneous coronary intervention (PCI) has become an option for these patients, but the data are limited. We therefore analyzed the clinical characteristics and the short-term and long-term outcomes of this subgroup of patients. METHODS This is a retrospective, single-center, observational study with 30 AMI patients admitted between July 2005 and March 2013 and treated with emergency PCI to an ULMCA culprit lesion. RESULTS Twenty-four males and 6 females with an average age of 63 ± 17 years were enrolled. Nineteen patients (63.3%) presented with ST-segment elevation MI, while 11 patients presented with non-ST segment elevation MI. Cardiac shock was present in 8 patients, total occlusion of left main coronary artery was identified by coronary angiography in 13 patients, and coexisting right coronary artery disease was present in 10 patients. Angiographic procedural success was achieved in 93% of patients, with intraaortic balloon pump used in 9 patients. Overall in-hospital mortality was 20%, all secondary to refractory cardiogenic shock and multiorgan failure. During a follow-up period of 1099 ± 819 days, no deaths or MIs were detected. Probability of freedom from death at 3 years was 79.7 ± 7.4%. CONCLUSIONS We demonstrate that in patients with LMCA disease in the setting of AMI, PCI is a feasible treatment option with an in-hospital survival of 80%. The long-term clinical outcome of patients surviving to hospital discharge is excellent.