purpose: To determine whether advancing age is an independent predictor of increased mortality following acute myocardial infarction or simply a marker for more extensive cardiac disease, a higher prevalence of comorbid conditions, and/or differences in therapeutic approach. patients: A total of 261 consecutive patients with documented acute myocardial infarction admitted to a university teaching hospital during a 1-year interval. methods: Seventy-four variables were analyzed to determine univariate predictors of inhospital and 1-year post-discharge mortality. Multiple linear regression models were constructed to determine independent predictors of early and late mortality after adjusting for baseline and therapeutic differences between younger and older patients. results: Compared with patients less than 70 years (n = 124), patients greater than or equal to 70 years (n = 137) were more likely (all p <0.05) to be female and have a prior history of ischemic heart disease. New York Heart Association functional class and Killip class on admission were higher in older patients, as were the admission serum creatinine and blood urea nitrogen levels. Serum albumin and peak creatine kinase levels were lower in older patients, but older patients were more likely to exhibit left ventricular hypertrophy or atrioventricular block on the initial electrocardiogram. Finally, younger patients were three times as likely to receive a thrombolytic agent and 66% more likely to receive intravenous β-blockade than older patients, and younger patients were also more likely to receive heparin and intravenous nitroglycerin. Hospital mortality was 5.6% in patients less than 70 years versus 16.1% in patients greater than or equal to 70 years (p = 0.013). After adjusting for baseline and therapeutic differences, independent predictors of hospital mortality were systolic blood pressure on admission (inverse correlation, p = 0.0095), β-blocker therapy (inverse correlation, p = 0.01), age (p = 0.014), peak creatine kinase level (p = 0.015), and Killip class (p = 0.035). Among hospital survivors, 1year post discharge mortality was 6.8% in patients less than 70 years versus 19.1% in those greater than or equal to 70 years (p = 0.001). Independent predictors of post-discharge mortality after adjusting for age-related baseline and therapeutic differences were admission heart rate (p = 0.0004), age (p = 0.011), left ventricular ejection fraction (inverse correlation, p = 0.012), initial non-Q-wave myocardial infarction (p = 0.026), and the blood urea nitrogen level (p = 0.036). conclusion: After adjusting for multiple baseline and therapeutic differences between older and younger patients, age per se remains a strong independent predictor of both inhospital and 1-year post-discharge mortality rates in patients with acute myocardial infarction.