Abstract: AIM:To identify high-risk patients in a timely manner, reduce the incidence of complications and apply effective treatment by analyzing the clinical features and prognosis in elderly patients with acute myocardial infarction (AMI). METHODS: Data of 146 elderly AMI patients (age ≥65 years) treated from January 2005 to May 2010 in our hospital were retrospectively analyzed, including age, gender, infarct location, onset time, onset month, time of hospital arrival, clinical symptoms, and cardiovascular events during the prior 30 days. RESULTS: Of the 146 patients, 57 were male (39.0%), ages (72±6) years and 89 were female (61.0%), ages (77±9) years (P<0.05). The incidence of anterior myocardial infarction was higher in male patients (40 cases, 27.4%) (P<0.05) and the incidence of inferior, right ventricular, and lateral myocardial infarctions were higher in female patients (65 cases, 44.5%) (P<0.01). The most frequent time of was from 05:00-08:59 am (53 cases, 36.3%), whereas the least frequent time was from 17:00-20:59 (nine cases, 6.2%) (P<0.01). The most frequent months of onset were October (23 cases, 15.8%), January (21 cases, 14.4%) and March (23 cases, 15.8%). Forty-four patients (30.1%) arrived at the hospital within 12 h and 88 cases (60.3%) arrived at the hospital from 12 h to 48 h (P<0.01). Twenty-nine cases (19.9%) had typical symptoms of chest pain and chest tightness, and 117 cases (80.1%) had other atypical symptoms (P<0.01). From the 30-day cardiovascular events it was reported that for elderly AMI patients with bradyarrhythmia and combined end point mortality, heart failure, III° AVB, incidence of sinus arrest and fatal arrhythmia of females is higher than the male group (all P<0.05), whereas ventricular fibrillation mortality, ventricular fibrillation, sustained ventricular tachycardia and incidence of lethal arrhythmia in males is higher than in females (all P<0.05). CONCLUSIONS: Elderly AMI patients show a gender difference in constituent ratio, age, infarct location, heart failure, type of fatal arrhythmias and mortality. Incidence of the maximum period is from 05:00 am to 08:59 am, and peak incidence months are October, January, and March. The number of hospital arrivals is highest at 12-48 h after onset. Most subjects have atypical clinical symptoms.