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As the population grows older, the burden of cardio-vascular disease is increasing rapidly. In spite ofthe larger numbers of very elderly patients with coronary syndromes, many questions about treatment and its effects on outcomes remain unanswered. The rapidly evolving management of patients with acute coronary syndromes over the past decades has led to improved survival rates.1–5 However, these improvements have been observed mainly among the younger segment of the popula-tion.6 The use of invasive procedures is increasing over time, but data are conflicting regarding the relative increase and effectiveness of these procedures in the very elderly popula-tion.3,4,7 Recent studies comparing early invasive and conserva-tive strategies in patients with non-ST-segment elevation acute coronary syndromes have suggested that the benefit of inva-sive care was greater among the oldest (aged 75 years or older) patients.8–11 Whether the results of these studies published at the beginning of the present decade led to substantial changes in practice in care of the very elderly population is unknown. The impact on long-term outcomes of these likely changes in patterns of practice is also unknown. Therefore, our objectives were to describe the temporal trends, over a decade, in use of invasive cardiac procedures and prescribing of medications after acute myocardial infarction in a population of patients aged 80 years old and over. We aimed to describe the changes in risk profiles of these patients and to describe temporal changes in short- and long-term outcomes