Objective: We aimed to compare the trend in clinical approach and interventions, in-hospital mortality rate in elderly patients with acute myocardial infarction (AMI) in a single reference center within subsequent years, 2000-2002. Methods: In our retrospective analysis within years 2000 and 2003 we could reach 160 eligible patients’ data files, who were hospitalized for of AMI and aged above 70 years. Results: Within three years we evaluated data of 105 male and 55 female eligible patients (mean age: 74±3.3 years). In-hospital mortality was observed in 39 (24%) patients with a median admission-to-mortality time of 24 hours. In 33 (20%) of the cases AMI involved more than one myocardial wall. Sixty-one percent of the whole population and 80% of the patients with early in-hospital mortality had reduced left ventricular ejection fraction. The comparison of treatment approaches within three years revealed a growing tendency for application of percutaneous transluminal coronary angioplasty (PTCA), surgical interventions and for the use of beta-blockers, angiotenzin converting enzyme inhibitors and lipid lowering agents (p<0.05). We did not observe any difference in mortality rates at subsequent years. Conclusion: In our single center analysis we observed changes in treatment policy in elderly AMI population, which was in concordance with the trends in international arena. But we were not able to show any reduction in mortality rate. Beyond the diverse ethnicity of our patient population, the relative delayed time to hospital admission, more extensive infarct area, lower administration of interventional procedures and primary PTCA, and most importantly the relative short time interval we analyzed may be contributing factors for still high in-hospital mortality in elderly population.