Abstract Background Elderly patients are underrepresented in acute myocardial infarction trials. Our aim was to determine whether, in elderly patients, changes in management in the past 15 years is associated with improved one-year mortality after hospital admission for myocardial infarction. Methods We used data from 4 one-month French registries, conducted 5 years apart from 1995 to 2010, including 3,389 elderly patients (≥75 years). Results From 1995 to 2010, mean age remained stable (82.1 years), similar in ST- and non-ST-elevation myocardial infraction patients. Obesity, diabetes, hypertension, and hypercholesterolemia increased. History of prior myocardial infarction, stroke and peripheral artery disease remained stable, while history of heart failure decreased. Major changes in management were noted: early percutaneous coronary intervention, early treatment with antiplatelet agents, low molecular weight heparin, beta-blockers, angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker and statins all increased. Early mortality after hospital admission decreased from 25.0% to 8.4%. One-year mortality decreased from 36.2% to 20.0% (adjusted hazard ratio 2010 vs 1995: 0.47, 0.39-0.57), both for ST-elevation myocardial infraction (36.8% to 21.1%) and non-ST-elevation myocardial infraction (34.8% to 19.1%). Mortality reduction was observed in all age groups, including those ≥85 years of age (from 46.2% to 31.4%). Study period, however was no longer associated with decreased mortality when variables reflecting management changes were taken into account. Conclusions Early and one-year mortality after hospital admission of elderly patients with acute myocardial infarction has dramatically decreased over the past 15 years. This improvement is likely mediated by increasing use of recommended management strategies. These data support the application of guidelines derived from trials mostly including younger patients to elderly populations as well.