Background: Despite well-documented improvements in short-term prognosis after a myocardial infarction, longer-term outcomes and health service costs are poorly defined. Aim: To provide a comprehensive account of the progression of coronary heart disease (CHD) after a myocardial infarction in the subsequent six to seven years. The long-term consequences and associated factors were examined in several separate but interrelated follow-up studies focusing on the following areas: (i) Mortality; (ii) socioeconomic status as a predictor of mortality; (iii) non-fatal CHD progression and preventive treatment; (iv) psychological health; and (v) health service use and cost. Methods: The patient cohort consisted of 1118 Oxfordshire residents aged 30 to 79 years diagnosed with a myocardial infarction in 1994-95 identified by the Oxford Myocardial Infarction Incidence Study (OXMIS). Studies undertaken: (1) Analyses of OXMIS databases, adding data from 1995 to 2001, with emphasis on 613 long-term survivors. (2) Review of hospital and general practice casenotes for 606 survivors. (3) Postal questionnaire study of 266 seven-year survivors. Main Results: By six years, amongst 28-day survivors: (1) 13% had died of CHD with no significant gender or socioeconomic differences. (2) 51% had experienced another non-fatal coronary event, of which 37% occurred within the first year. Subsequent annual rates reduced substantially, but continued at 4% per year. Most coronary preventive medications were initiated at either hospital discharge or within the first year. After hospital discharge, CHD health service costs for the first year were £1700 per patient. From the third year onwards, these annual costs reduced to £600. (3) At seven years, the prevalence of poor psychological health was 15%. Patients with current angina symptoms were twice as likely to be emotionally distressed as those with no angina. Conclusion: In 28-day infarct survivors, the first year was the time of highest risk for subsequent CHD events and associated health service costs. Nevertheless, risk of CHD mortality in the cohort was higher than that of the general population over the following five years.