Objectives. To evaluate the prognostic role of functional status in older adults hospitalized for acute coronary syndrome (ACS) and the implications of the coronary event on functional decline during follow-up. Materials and methods. This was a single-center, prospective cohort study including patients aged ≥65 years hospitalized for ACS with (STEMI) or without ST-segment elevation in 2022. Patients with total dependence or lacking a care network were excluded. Functional status was assessed using the Barthel Index and the Lawton and Brody scales at admission, 30 days, and one year post-discharge. The association between initial functional status and major adverse cardiovascular events (MACE) was analyzed, as well as the impact of ACS on functional status over the short and long term. Results. A total of 110 patients older than 65 years were included (mean age 78.8±4.6 years; 61.8% ma...