Cardiogenic acute pulmonary edema (APE) associated with coronary artery disease was diagnosed in 44 patients admitted over a 1-year period to a general university hospital. The patients' clinical characteristics at presentation were variable. Acute myocardial infarction (AMI) was present in 26 patients (59%). The hospital mortality rate was 46% (12 of 26 patients) in the presence of AMI and 6% (1 of 18) in its absence (p = 0.006). Long-term follow-up of all hospital survivors revealed that 8 of 30 (27%) had died at 1 year and that 21 of 30 patients (70%) had died at 6 years. However, there was no significant difference in subsequent survival between the AMI and non-AMI groups. A history of congestive heart failure was selected as the most important predictor of increased mortality risk by univariate analysis of the clinical characteristics of the hospital survivors (p = 0.02). The mortality rate at 6 years of follow-up was 85% (17 of 20 patients) in the presence of a history of congestive heart failure and 40% (6 of 10) in its absence.