Guidelines recommend managing patients aged ≥75 with non-ST-segment elevation myocardial infarction (NSTEMI) similar to younger patients. We analyze disparities in NSTEMI management and compare those ≥80 years to those <80 years. This is a matched case-control study using the 2016 National Inpatient Sample data of adults with NSTEMI receiving percutaneous coronary intervention with drug-eluting stent (PCI-DES) - one artery or no intervention. We included the statistically significant variables in univariate analysis in exploratory multivariate logistic regression models. Total sample included 156,328 patients, out of which 43,265 were ≥ 80 years, and 113,048 were < 80 years. Patients ≥80 years were more likely to not have an intervention (73.3%) when compared to those <80 (44.1%), P < 0.0005. Regardless of age, PCI-DES-one artery improved survival compared to no intervention (Age < 80: OR 0.230, 95% CI 0.189–0.279, and ≥ 80: OR 0.265, 95% CI 0.195–0.361, P < 0.0005). Women (OR 0.785, 95% CI 0.766–0.804, P < 0.0005) and non-white race (OR 0.832, 95% CI 0.809–0.855, P < 0.0005) were less likely to receive an intervention. Non-Medicare/Medicaid insurance was associated with 40% lower likelihood of dying in <80 age group (OR 0.596, 95% CI 0.491–0.724, P < 0.0005), and 16% higher chance of intervention overall (OR 1.160, 95% CI 1.125–1.197, P < 0.0005). Patients aged ≥80 with NSTEMI were 29% less likely to receive an intervention compared to patients aged <80, even though patients >80 derived similar mortality benefits from the intervention. There were gender, payor, and race-based disparities in NSTEMI management in 2016. •NSTEMI patients ≥80 years get PCI-DES one artery at <50% of the rate in <80 years.•Intervention is equally beneficial in both patients <80 and ≥ 80 years.•Women are 21.5% less likely to get intervention for NSTEMI compared to men.•Non-white race has a 16.8% less likelihood of intervention.•Non-Medicare/Medicaid: 40% lower mortality in age < 80; 16% higher intervention.