The purpose of this study was to define the clinical features of acute myocardial infarction in a group of elderly Chinese. The presenting symptoms, complications and mortality of acute myocardial infarction were compared in 631 patients (430 men and 201 women) aged 60 and over and 389 patients (333 men and 56 women) whose ages were under 60 years. The incidence of painless myocardial infarction was 17.6% in the elderly versus 5.9% in the younger group. Typical chest pain was present in 63.1% of the elderly and 84.3% of the younger Chinese. However, the incidence of other nonspecific presenting symptoms was higher in the elderly group. Likewise, the major complications in the elderly group were more severe than those in the younger group. For example, the incidences of cardiogenic shock, heart failure, arrhythmia, pulmonary infection and cardiac rupture in the older group were 19.8, 24.2, 77.2, 22.0 and 4.4%, versus 15.1, 19.5, 48.1, 9.5 and 1.1% in the younger group, respectively. The immediate (4 week) mortality rate of the older group was 21.9% (over 80 years 51.5%), but was only 11.0% in the younger group. Although the incidences of hypertension and pulmonary disease were significantly greater in the elderly group, these diseases alone did not account for the higher mortality rate in the elderly.