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Aims The management of acute myocardial infarction (AMI) in elderly patients is often challenging for their peculiar clinical profile and the limited clinical evidence available. This represents a major unmet need in cardiovascular medicine, given the progressive ageing of population in western Countries. To investigate the clinical characteristics of elderly patients with AMI at a single tertiary university hospital. Methods and results The EMIR is an ongoing registry including elderly patients (≥75 years) consecutively referred to a single tertiary centre with diagnosis of acute myocardial Infarction with indication for coronary angiography. A total of 760 patients were enrolled to date, 39.6% were female, while mean age was 80 ± 4 years. Most patients had a NSTEMI, while 28% had a STEMI. Time from symptoms’ onset to presentation was 9.4 ± 14.6 for STEMI and 26.5 ± 30.4. Percutaneous coronary intervention (PCI) was performed in 64% of cases. Concomitant PCI of a non-target lesion (NTL) was performed within the same procedure in 8.8% of cases. A staged PCI of NTL was performed in 14% of cases. An elective surgical revascularization was performed after PCI of the IRA in 2.1% of cases. Altogether, a complete revascularization was achieved in 43% of cases before discharge. No evidence of critical coronary stenoses (CCS) was reported in 12.1% of cases, more frequently in females (18%) than in males (8.3%). Patients with no CCS were younger (P = 0.007), more frequently female (P &amp;lt; 0.001), had lower LV-EF (P = 0.002) and a longer time from symptoms’ onset to presentation (P = 0.008). Atrial fibrillation (AF) was present in 17.4% of patients, although only 12.1% of patients had any knowledge of carrying AF. Among patients with AF, 16.7% had no CCS, while the remaining had a formal indication to a combined antiplatelet/anticoagulant treatment. Conclusions Elderly patients with AMI are a specific population, posing peculiar clinical needs and demanding dedicated clinical management protocols.

729 Clinical profile and management of acute myocardial infarction in elderly patients