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Background: Pain is associated with cardiovascular risk, but its prognosis after myocardial infarction (MI) is less studied. We evaluated general pain post-MI as a marker for MACE (all-cause mortality, recurrent MI, or stroke) and all-cause mortality.

Methods and results: We collected data from 98,441 MI patients (22-79 years) from the Swedish quality register SWEDEHEART. Pain, measured by EuroQol-5, was recorded one-year post-MI. Moderate pain was reported by 38.0 % of the patients and extreme pain by 5.0 %. During follow-up (up to 16.0 years (median 5.5 years)) there were 14,944 deaths and 24,910 MACEs.

In adjusted Cox regression models, moderate and extreme pain were associated with all-cause mortality in men (hazard ratio (HR) 1.24, 95 % confidence interval (CI) 1.19-1.29 and HR 1.70, 95 % CI 1.54-1.86, respectively,) and in women (HR 1.15, 95 % CI 1.08-1.23 and HR 1.31, 95 % CI 1.16-1.48, respectively,). The population attributable fraction (PAF) for moderate and extreme pain combined, with outcome all-cause mortality, was 8.3% for men and 6.3 % for women, similar to PAF for smoking, diabetes, and hypertension. Compared to all-cause mortality, HRs for MACE were somewhat lower in men and similar in women. For patients with lower cardiovascular risk defined, among other factors, by absence of chest pain, HRs were comparable to those in the main sample.

Conclusions: Self-reported pain after MI was common and linked to increased cardiovascular risk, similar to that of smoking, diabetes, and hypertension. Clinicians may consider general pain in prognosis and treatment, even for patients without chest pain.