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Long-lived individuals are systematically excluded from large studies, creating a gap in the evidence base for managing myocardial infarction (MI) in this age group. Aim - to research the features of MI course and outcomes in long-lived patients depending on treatment strategies. Retrospective analysis of 32 medical records of long-lived patients (≥90 years) with MI. Clinical, laboratory, instrumental data, and treatment outcomes were evaluated. The mortality rate was 37,5%. Characteristic features included high comorbidity (100% - hypertension, 50% - atrial fibrillation). The most unfavorable prognostic factors were acute heart failure, atrial fibrillation, as well as elevated creatinine and leukocyte levels. Mortality in the percutaneous coronary intervention group was lower than in the conservative treatment group (27% vs. 43%). MI in long-lived patients occurs against a background of high comorbidity. Percutaneous coronary intervention is associated with lower mortality; however, this issue requires further prospective studies.