Abstract: Objective To investigate the influence of symptom onset-to-first medical contact(SO-to-FMC)time on prognosis of elderly patients with acute ST-segment elevation myocardial infarction(STEMI)in rural areas of Three Gorges reservoir area. Methods Eighty seven patients with STEMI were divided into SO-to-FMC≤6 h group(n=48)and SO-to-FMC>6 h group(n=39). The survival rate, left ventricular ejection fraction(LVEF), results of 6-minute walking test(6MWD)and New York Heart Association(NYHA)classification were compared between the two groups. Results The survival rate of the SO-to-FMC≤6 h group was 97.9%, which was significantly higher than 87.2% of the SO-to-FMC>6 h group(P=0.04). The 6MWD of the SO-to-FMC≤6 h group was(376.8±115.8)meters, which was significantly longer than(318.3±110.8)meters in the SO-to-FMC>6 h group(P<0.05). The LVEF of the SO-to-FMC≤6 h group was(57.2±7.2)%, which showed no significant difference when compared to(54.5±6.6)% of the SO-to-FMC>6 h group(P>0.05). The result of NYHA cardiac function classification in the SO-to-FMC≤6 h group was significantly better than that in the SO-to-FMC>6 h group(P<0.05). Conclusion Shortening the SO-to-FMC time can effectively improve the survival rate and prognosis of STEMI patients.