Background: Deferred stenting has been recognized as beneficial for patients with acute ST-segment elevation myocardial infarction (STEMI) accompanied by a high thrombus burden. Nevertheless, its efficacy and safety specifically in geriatric STEMI patients remain to be elucidated. This study aims to bridge this knowledge gap and assess the potential advantages of deferred stenting in an older patient cohort. Methods: In this study, 208 geriatric patients (aged \ge80 years) with STEMI and a high thrombus burden in the infarct-related artery (IRA) were enrolled. They were categorized into two groups: the deferred stenting group, where stent implantation was conducted after 7–8 days of continuous antithrombotic therapy, and the immediate stenting group, where stent implantation was performed immediately. Results: In the deferred stenting group, the stents used were significantly larger in diameter and shorter in length compared to those in the immediate stenting group (p 0.05). This group also exhibited a lower incidence of distal embolism in the IRA, and higher rates of the thrombolysis in myocardial infarction (TIMI) blood flow grade 3 and myocardial blush grade 3 (p 0.05). Additionally, the left ventricular ejection fractions at the 1-year follow-up were significantly higher in the deferred stenting group than in the immediate stenting group (p 0.05). The rate of the major adverse cardiac events in the deferred stenting group was significantly lower than in the immediate stenting groups (p 0.05). Conclusions: Deferred stenting for geriatric patients with STEMI and high thrombus burden demonstrates significant clinical benefits. This approach not only reduces the incidence of distal embolism in the IRA, but also enhances myocardial tissue perfusion and preserves cardiac ejection function. Moreover, deferred stenting has proven to be safe in this patient population, indicating its potential as a preferred treatment strategy in such cases.