AIMS: To compare the outcome after primary percutaneous coronary intervention (PPCI) according to sex and age, including comparison of sex- and age-specific mortality of PPCI patients with that of the general population. METHODS AND RESULTS: This population-based follow-up study included 7,385 STEMI patients treated with PPCI and 42,965 matched general population controls. The primary outcome was the composite endpoint of mortality, reinfarction, and stroke at 30 days, one year, and two years. Women were older and had a more adverse baseline risk profile than men. The risks of the composite endpoint after 30 days, one year, and two years were 9.1%, 16.0%, and 20.0%, respectively, for women compared to 5.8%, 10.6%, and 14.0% for men (adjusted hazard ratio [HR] [30 days]=1.16 [0.95-1.41], adjusted HR [one year]=1.18 [1.02-1.37], and adjusted HR [two years]=1.14 [0.99-1.30]). The risk of an adverse outcome increased similarly among women and men with increasing age. When comparing patients and controls, we found a higher mortality among patients up to 90 days after PPCI. However, after 90 days, the mortality among the PPCI patients was comparable to the mortality in the general population in all sex and age groups. CONCLUSIONS: Clinical outcome after PPCI was comparable in men and women after controlling for possible confounding. After 90 days post-PPCI, the mortality of treated patients was comparable to the mortality of the general population, independent of sex and age.