BACKGROUND:The rates of cardiovascular (CV) events are highest in the period immediately after an initial MI but may remain elevated for an extended period of time.  OBJECTIVES: Evaluate long-term rates of CV events (recurrent myocardial infarction (MI) and hospitalized stroke) and all cause mortality in patients with stable CAD after MI and in patients resembling those of the PEGASUS trial (NCT 01225562).  METHODS: Patients ≥50 years old (yo) with an MI followed by ≥ 12 MI-free months (stable CAD) and no prior stroke were identified from a large claims database between 01/2007 and 11/2011.  Inclusion and exclusion criteria were identified during a 12 month pre-MI baseline.  Patients included in the PEGASUS-like cohort were those having at least one additional risk factor (≥1 additional prior MI, Age≥65, diabetes or chronic non-end-stage renal disease (NESRD)).  Rates of a composite endpoint (MI or stroke hospitalization or all-cause mortality) in the stable CAD and PEGASUS-like populations were estimated during follow-up (up to four years) after the stable CAD index.  Due to data and population limitations, rates were compared in patients <65 yo only. RESULTS:  In the <65 yo PEGASUS-like cohort, 24.4% had ≥1 additional prior MI, 76.1% had diabetes, and 27.4% had NESRD.   Event rates for the PEGASUS-like (n= 5,357) and other stable CAD cohorts (n= 8,135) were 60/1,000 and 27/1,000 person-years (py), respectively (p<0.0001).  Hospitalized MI was the largest contributor to the composite endpoint (38/1,000 and 19/1,000 py, respectively, p<0.0001).  Composite event rates in PEGASUS-like patients who were still MI-free 2 and 3 years after the index MI were 51/1,000 py and 44/1000 py, respectively.   CONCLUSIONS:  Stable CAD patients in the US meeting PEGASUS clinical trial criteria continue to have an elevated risk of major CV events and all cause mortality after several MI-free years.