581 consecutive patients admitted to hospital for acute myocardial infarction between January 1983 and June 1985 were divided into two groups. Group A (286) patients were aged 70 years or over (76 +/- 4 years); those in group B (246) were 65 or younger (56 +/- 8 years). Group A patients had a significantly higher incidence of anterior-wall infarction (30% vs. 18% in group B); heart failure (55% vs. 32%); pulmonary oedema (18% vs. 6%); cardiogenic shock (17% vs. 6.5%); or rupture (6% vs. 2%). Patients of the older age group also significantly less often underwent systemic fibrinolysis (0.3% vs. 21%); coronary angiography (2% vs. 61%); percutaneous transluminal coronary angioplasty (PTCA) or aorto-coronary bypass operation (0% vs. 22%) (P = 0.00001). Among the older patient group the cumulative mortality rate during hospitalization was 26.9% vs. 11.8% in group B, after six months it was 39% vs. 15%, after 12 months 46% vs. 17%, and after 24 months 61% vs. 21% (P = 0.00001). Causes of death were comparable in the two age groups, cardiac ones predominating. Angina in NYHA classes III-IV after discharge was present in 10% of the younger but 38% among the older patients (P = 0.00001). The death rate in patients of group A was very high under conservative treatment and surviving patients had a poor quality of life. Yet both coronary artery surgery and PTCA gave demonstrably better long-term results, both as to function and survival. Therefore, patients of even this higher age should more than is the case at present be more aggressively treated with invasive diagnostic and therapeutic procedures.

The implications of apolipoproteins A-I and A-II for the prognosis of 178 non-diabetic men after acute myocardial infarction were studied. During a mean follow-up period of 4 years, one or more "coronary events" (nonfatal myocardial infarction, fatal coronary heart disease, coronary artery bypass graft surgery, deterioration of exercise ECG) were recorded in 37 patients. Serum levels of apolipoproteins A-I and A-II did not discriminate between patients with and without coronary events. This applied to the entire sample as much as to subgroups defined by presence or absence of interventions (coronary artery bypass graft surgery, long-term therapy with beta-blockers or lipid-lowering drugs). We conclude that coronary events in the first years after myocardial infarction cannot be predicted by apolipoprotein A-I or A-II levels.