Elderly patients form an increasingly large proportion of people with acute myocardial infarction, and advanced age is a strong predictor of a high risk of death or of serious complications after acute myocardial infarction.1 Paradoxically, elderly patients with acute myocardial infarction have been excluded or under-represented in most clinical trials, and limited data are available to guide their care. Studies of prognosis after acute myocardial infarction in the elderly are also scant,2 and it is unclear whether or not the established predictors of high risk of death after acute myocardial infarction in the general population are useful in the elderly.

In the linked study (doi:10.1136/bmj.b1605), Lorgis and colleagues studied a non-selected cohort of 3291 patients with acute myocardial infarction and showed that circulating concentrations of the N-terminal fragment of B type natriuretic peptide (BNP) prohormone (NT-ProBNP), had an incremental prognostic value in elderly patients, beyond established prognostic markers, such as …