Background: This study aimed to compare the clinical characteristics, risk factors, treatment regimens, and outcomes of Acute Coronary Syndrome (ACS) in elderly patients (≥65 years) versus younger patients (<65 years) admitted to the Intensive Care Unit (ICU) of a tertiary hospital. Materials and Methods: This retrospective cohort study included 80 patients diagnosed with ACS, divided into two groups: elderly (≥65 years, n=40) and young (<65 years, n=40). Data were collected from the hospital’s electronic medical records, including demographics, clinical presentation, risk factors, laboratory findings, treatment regimens, and outcomes. Statistical analyses were performed using SPSS version 16.0, with a p-value < 0.05 considered significant. Results: No significant gender differences were found between the elderly and young groups (p=0.54). Clinical presentation revealed no significant differences in chest pain, shortness of breath, and sweating (p>0.05). Smoking was more prevalent in the young group (50.00% vs 30.00%, p=0.05). There was no significant difference in antiplatelet use (85.00% vs 80.00%, p=0.47), but younger patients were more likely to undergo percutaneous coronary intervention (60.00% vs 40.00%, p=0.05). The mortality rate was higher in the elderly group (15.00% vs 5.00%, p=0.05). Conclusion: This study highlights the higher mortality rate in elderly patients with ACS, emphasizing the need for tailored management strategies. While both groups share common risk factors, younger patients are more likely to receive invasive treatments like PCI. These findings underline the importance of early intervention in elderly ACS patients to improve their outcomes.