Recent information on differences in presentation, evolution, therapy and outcome of myocardial infarction (MI) between age groups consists mainly of the result of clinical trials, evaluating highly selected patients and can therefore be difficult to extrapolate. We studied age-related differences in 167 consecutive typical cases, admitted in our hospital. Twenty-nine percent of patients were ≧ 75 years. With increasing age, the proportion with previous MI, old Q waves, absence of new Q waves, anterior or unknown site and bundle branch block rose. Atypical presentation was more common in patients ≧75 years. Fewer patients of higher age groups received thrombolytics and beta-blockers. In-hospital mortality rose from 5% in the youngest to 33% in the highest age group, and was also related to the presence of old Q waves. Mortality after discharge, however, is more closely related to functional status at discharge.