Abstract. Karlson BW, Wiklund O, Hallgren P, SjoÈlin M, Lindqvist J, Herlitz J (Sahlgrenska University Hospital, GoÈteborg, Sweden). Ten-year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia. J Intern Med 2000; 247: 449±456. Aim. To evaluate the long-term prognosis amongst patients with a very small or unconfirmed acute myocardial infarction (AMI) in relation to clinical history, metabolic screening and signs of myocardial ischaemia at exercise test. Methods. Patients with a very small or unconfirmed AMI, aged , 76 years, were selected and given a clinical evaluation, metabolic screening and checked for ischaemia at an exercise test 4 weeks after admittance. The 10-year mortality was related to age, sex, clinical history, body weight, serum (S) cholesterol, S-triglycerides, S-gammaglutamyltranspeptidase (GT), S-glucose and various indices of myocardial ischaemia at exercise test. Results. In all, 714 patients participated in the evaluation. The median age was 63 years and 33% werewomen. The overall 10-year mortality was 33%. In univariate analysis, the following factors appeared as risk indicators for death: age (P , 0.0001), a history of previous AMI (P , 0.0001), angina pectoris (P , 0.001), diabetes mellitus (P , 0.0001), congestive heart failure (P , 0.0001), smoking (P = 0.030), S-triglycerides (P , 0.0001), S-gamma GT (P , 0.0001) and Sglucose (P , 0.0001). In multivariate analysis, the following remained as independent risk indicators for death: age (P , 0.0001), S-gamma GT (P , 0.0001), previous AMI (P , 0.0001), smoking (P , 0.0001) and Sglucose (P = 0.010). Conclusion. Amongst patients with a very small or a unconfirmed AMI, factors reflecting their clinical history, including age, a history of AMI and current smoking, as well as factors reflecting their metabolic status, including S-gamma GT and S-glucose, were important predictors for the long-term outcome.