Although a substantial reduction in post-myocardial infaction mortality has been obtained in recent decades, one-year mortality rates are still high and 20% of patients who survive after the acute phase suffer a second cardiovascular event in the first year. In the setting of secondary cardiovascular prevention, the long-term cardiovascular risk stratification represents one of the most interesting and charming challenge for physician. Lifestyle changes and long-term control of traditional cardiovascular risk factors remain the cornerstone of secondary cardiovascular prevention and continue to offer the most powerful prognostic implications in the field of preventive cardiology with strong evidence of reduction in mortality and morbidity. In this regard, clinical, ECG, echocardiographic, cardiopulmonary exercise test data as well as biochemical markers of adverse prognosis are useful tool to identify patients at risk of developing future cardiovascular events. An integrated approach based on the analysis of all cardiovascular risk factors (traditional and emerging) along with instrumental and laboratory data represents the better way to predict prognosis in secondary cardiovascular prevention.