Objective To investigate gender differences in risk factors and auxiliary examination findings among elderly patients with acute myocardial infarction (AMI). Methods A retrospective analysis was conducted on the clinical data from 532 elderly AMI patients (357 males and 175 females) admitted to Department of Cardiology of General Hospital of Central Theater Command from May 2023 to April 2025. Differences in personal history, laboratory indicators, echocardiographic (ECG) parameters, and coronary angiography results were compared between different sexes. SPSS statistics 26.0 was used for statistical analysis. Depending on data type, t test, Mann-Whitney U test, or Chi-square test were applied for intergroup comparisons. Results The proportions of smoking history and drinking history were significantly higher in the elderly male patients than the females (P<0.001). The female patients had lower red blood cell counts, and hemoglobin and serum potassium levels but higher total cholesterol, low-density lipoprotein cholesterol, blood glucose, N-terminal pro-brain natriuretic peptide and D-dimer levels compared to the males (P<0.05). ECG finding revealed that smaller left atrial diameter and left ventricular diameter, and thinner interventricular septum thickness were observed in the female patients (P<0.001), while no such differences were seen in the indicators of left ventricular systolic function (P>0.05). In terms of coronary artery lesions, there was no significant difference in the proportion of three-vessel disease or in the Gensini score for coronary arteries between the female and male patients (P>0.05). Conclusion Significant differences exist in risk factors and laboratory indexes between elderly male and female AMI patients. Risk factors for AMI in elderly men are mainly smoking and alcohol consumption, whereas women are more affected by metabolic abnormalities. Clinical management should implement targeted interventions based on sex differences.