In comparing the cause of death and other cardiac morphologic findings among 60 women and 40 men aged >75 years who died of acute myocardial infarction, we found that women died more often from mechanical complications than left ventricular pump failure. Women had cardiomegaly, nonanterior location of acute myocardial infarction, healed myocardial infarcts, and dilated left ventricular cavity less often than men.