Aims Sense of coherence (SOC) allows individuals to be more resilient to adverse life events, and it is associated with quality of life (QoL), but its long-term effects are unknown in patients with myocardial infarction. This study aimed to examine longitudinal variations of SOC and associations between SOC at baseline and QoL at a 10-year follow-up in relation to gender.Methods and results This longitudinal study included 61 patients, 16 women and 45 men with a mean age of 57.1 +/- 6.5 years, who completed a questionnaire package in relation to hospital discharge, 2 years, 5 years, and 10 years later. The questionnaire package included the Sense of Coherence Scale (SOC-13), 12-item Short Form Health Survey, and Seattle Angina Questionnaire. Data were analysed with repeated measure ANOVA and linear regression. Overall, SOC was stable over the 10-year follow-up, but comprehensibility improved significantly (P = 0.003). A significant main effect for gender was shown regarding SOC total (P = 0.032) and comprehensibility (P = 0.034); women reported lower SOC compared with men. An interaction effect between gender and time was shown in comprehensibility (P = 0.007), as the differences between genders decreased over time. The SOC-13 was significantly associated with all dimensions of QoL; three significant interaction effects showed that the associations were true for women but not for men.Conclusion The SOC is an important aspect to consider in the care of patients with myocardial infarction, as it is associated with long-term QoL, particularly for women. This means that SOC can also be used to identify patients who are at risk for poor QoL after a myocardial infarction.