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Background  Long‐term prognosis of acute pulmonary edema ( APE ) remains ill defined.    Methods and Results  We evaluated demographic, echocardiographic, and angiographic data of 806 consecutive patients with  APE  with ( CAD ) and without coronary artery disease (non‐ CAD ) admitted from 2000 to 2010. Differences between hospital and long‐term mortality and its predictors were also assessed.  CAD  patients (n=638) were older and had higher incidence of diabetes and peripheral vascular disease than non‐ CAD  (n=168), and lower ejection fraction. Hospital mortality was similar in both groups (26.5% vs 31.5%;  P =0.169) but  APE  recurrence was higher in  CAD  patients (17.3% vs 6.5%;  P <0.001). Age, admission systolic blood pressure, recurrence of  APE , and need for inotropics or endotracheal intubation were the main independent predictors of hospital mortality. In contrast, overall mortality (70.0% vs 57.1%;  P =0.002) and readmission for nonfatal heart failure after a 45‐month follow‐up (10–140; 17.3% vs 7.6%;  P =0.009) were higher in  CAD  than in non‐ CAD  patients. Age, peripheral vascular disease, and peak creatine kinase  MB  during index hospitalization, but not ejection fraction, were the main independent predictors of overall mortality, whereas coronary revascularization or valvular surgery were protective. These interventions were mostly performed during hospitalization index (294 of 307; 96%) and not intervened patients showed a higher risk profile.    Conclusions  Long‐term mortality in  APE  is high and higher in  CAD  than in non‐ CAD  patients. Considering the different in‐hospital and long‐term mortality predictors herein described, which do not necessarily involve systolic function, it is conceivable that a more aggressive interventional program might improve survival in high‐risk patients.

Hospital and 4‐Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease