Background: Evidence is lacking on long-term outcomes in unselected patients surviving the first year following myocardial infarction (MI)., Methods and Results: The TIGRIS (long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients) prospective registry enrolled 9176 eligible patients aged ≥50 years, 1-3 years post-MI, from 25 countries. All had ≥1 risk factor: age ≥ 65 years, diabetes mellitus, second prior MI, multivessel coronary artery disease, chronic kidney disease (CKD). Primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death at 2-year follow-up. Bleeding requiring hospitalization was also recorded. 9027 patients (98.4%) provided follow-up data: the primary outcome occurred in 621 (7.0%), all-cause mortality in 295 (3.3%), and bleeding in 109 (1.2%) patients. Events accrued linearly over time. In multivariable analyses, qualifying risk factors were associated with increased risk of primary outcome (incidence rate ratio [RR] per 100 patient-years [95% confidence interval]): CKD 2.06 (1.66, 2.55), second prior MI 1.71 (1.38, 2.10), diabetes mellitus 1.63 (1.39, 1.92), age ≥ 65 years 1.53 (1.28, 1.83), and multivessel disease 1.24 (1.05, 1.48). Risk of bleeding events was greater in older patients (vs <65 years) 65-74 years 2.68 (1.53, 4.70), ≥75 years 4.62 (2.57, 8.28), and those with CKD 1.99 (1.18, 3.35)., Conclusion: In stable patients recruited 1-3 years post-MI, recurrent cardiovascular and bleeding events accrued linearly over 2 years. Factors independently predictive of ischemic and bleeding events were identified, providing a context for deciding on treatment options., Competing Interests: Declaration of competing interest D.B. Speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly and Company, Merck, Novartis, Sanofi. S.J.P. Statistical consulting honoraria from AstraZeneca. S.B. Speaker/consulting honoraria and/or research grant support from Abbott, Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Medtronic, Novartis, Pfizer, Roche, Siemens, Siemens Diagnostics, Thermo Fisher Scientific. J.-Y.C. Research grant support from AstraZeneca; consulting honoraria from MicroPort, APT Medical and JW Medical. M.G.C. Speaker/consulting honoraria and/or research grant support from AstraZeneca, Medtronic, Abiomed, Merit Medical. C.B.G. Consulting honoraria and/or research grant support from Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly and Company, Gilead, GlaxoSmithKline, F. Hoffmann-La Roche, Janssen Pharmaceuticals, Metronic, Pfizer, Salix Pharmaceuticals, Sanofi, Takeda Pharmaceutical Company, The Medicines Company. R.G. None. J.C.N. Speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, BMS, CLS Behring, Pfizer, Sanofi. T.S. Speaker/consulting honoraria and/or research grant support from Astellas, Amgen Inc., AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmithKline, Merck, Novartis, Pfizer, Sanofi. D.W. Speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Berlin-Chemie, Biotronik, Novartis. S.Y. Speaker/consulting honoraria and/or research grant support from Takeda Pharmaceutical Company, Daiichi-Sankyo, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb. J.G. Grants from AstraZeneca during the conduct of the study and outside the submitted work. K.L.R. Employee of OXON Epidemiology Ltd., and paid consultant to AstraZeneca in connection with the conduct, data management and analyses of this study. K.H. Employee of AstraZeneca. K.A.S. Employee of AstraZeneca. S.G.G. Speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo, Eli Lilly and Company, Fenix Group International, Ferring Pharmaceuticals, GlaxoSmithKline, Janssen/Johnson & Johnson, Luitpold Pharmaceuticals, Matrizyme, Merck, Novartis, Pfizer, Regeneron, Sanofi, Servier, Tenax Pharmaceuticals, HLS Therapeutics, Novo-Nordisk., (Copyright © 2020. Published by Elsevier B.V.)