Reperfusion therapy by thrombolysis or angioplasty was considered in 260 unselected patients consecutively admitted within 6 h of the onset of Q wave myocardial infarction. Rates of reperfusion and in-hospital mortality were compared in 206 patients < 70 years and 54 patients > or = 70 years. Early reperfusion was obtained in 86.4% of the patients under 70 years and in 72.2% of those over 70 (P < 0.01). Thrombolysis was more frequently used in the younger group (66.0% vs 31.5%, P < 10(-5)), and primary angioplasty in the older (44.4% vs 29.6%, P < 0.05). Overall in-hospital mortality was higher in the older group (22.2% vs 4.4%, P < 10(-5)). After successful reperfusion, mortality was 12.8% in the patients over 70 and 3.9% in those under 70. After failed or unproven reperfusion, mortality was 46.7% in the patients over 70 and 7.1% in those under 70. Reperfusion therapy is feasible in the majority of patients over 70 years, but failure to attempt or to achieve reperfusion is associated with a poor outcome. Although not controlled, this study provides an incentive for attempting early reperfusion therapy as often as possible in the elderly with acute myocardial infarction.