Background: This study aims to describe independent risk indicators for death and mode of death after development of acute myocardial infarction in relation to age. Methods: Nine hundred twenty-one consecutive patients admitted to Sahlgrenska Hospital, Goteborg, Sweden, suffering from acute myocardial infarction were prospectively followed for 1 year. The patients were divided into two age groups, 76 years old and above or below 76 years old, because there was an equal number of deaths in these two groups. Results: In the older group, the following were independent risk indicators for death at 1 year of follow-up, in order of significance: 1) previous infarction (P< 0.01); 2) ST-segment elevation on admission (P< 0.01); 3) arrhythmia at onset of infarction (P< 0.05); and 4) age (P< 0.05). In patients 76 years old or less the following were risk indicators: 1) age (P < 0.001); 2) history of congestive heart failure (P< 0.01); 3) loss of consciousness at onset of infarction (P< 0.01); 4) acute congestive heart failure at onset of infarction (P< 0.05); 5) unspecific symptoms at onset of infarction (P< 0.05); and 6) history of hypertension (P< 0.05). In both age groups risk indicators for death during hospitalization differed from risk indicators for death after discharge from the hospital. During hospitalization, the elderly more frequently died in association with congestive heart failure and less frequently in association with ventricular fibrillation as compared with younger patients. Conclusions: In the elderly (>76 y) with acute myocardial infarction, risk indicators for death differ from those in younger patients. Symptoms associated with death are also not the same in patients 76 years old as compared with younger patients.