Aim: To examine trends in incidence and 28-day case fatality of myocardial infarction (MI) in persons aged 75–99 years in four areas of Finland.

Methods and results: The Finnish Acute Myocardial Infarction (FINAMI) register is a population-based MI register study, which during 1995–2012 recorded 30561 suspected acute coronary syndromes in persons aged ≥75 years. Of them, 16229 fulfilled the American Heart Association criteria for a definite, probable or possible MI or coronary death. This age-group contributed 56.8% of all MIs of which 62.7% occurred in women. The incidence of MI decreased by −3.3%/year (95% CI −4.2; −2.4) in women aged 75–84 years, and by −1.2%/year (−1.9; −0.5) in women aged 85-99 years, but among men in these age-groups, only a non-significant reduction occurred. The 28-day case fatality of MI was high. In the age-group 75–84 years, it decreased non-significantly by −1.6%/year in men, and significantly by −2.4%/year (−3.9; −0.8) in women. In the age-group 85–99 years, the decrease was more remarkable: −5.1%/year (−7.8; −2.3) and −3.9%/year (−5.5; −2.2), respectively.

Conclusions: In Finland, more than half of MIs occur in the age-group 75–99 years, and most of them in women. The incidence of MI decreased significantly in elderly women but non-significantly in elderly men. The 28-day case fatality decreased especially in the age-group 85–99 years.