Background: A few recent studies have evaluated diagnostic accuracy by comparison between clinical and autopsy diagnoses in a hospital specialising in cardiology. Methods: 406 consecutive autopsy cases during 2 years were studied. Patients were aged 47.4¡28.4 years; 236 (58.1%) were men and 170 (41.9%) women. Diagnostic comparison was categorised in classes I to V (I, II, III and IV: discrepancy in decreasing order of importance regarding therapy and prognosis; V: concordance). Categorisation was ranked on the basis of the highest degree of discrepancy. Statistical analysis was performed with the X 2 test and stepwise logistic regression. Results: Each age increase of 10 years added 16.2% to the risk of the diagnostic comparison to be categorised in classes I and II (major discrepancy) in comparison to classes III, IV and V (OR 1.16, 95% CI 1.07 to 1.27, p,0.001). By contrast, admission to intensive care units decreased the risk of categorisation in classes I and II by 47% (OR 0.53, 95% CI 0.32 to 0.85, p = 0.009). The most frequent diagnostic discrepancy occurred for pulmonary embolism: 30 out of 88 (34.1%) diagnoses in classes I and II. The concordance rate was 71.1% for acute myocardial infarction, 75% for aorta dissection, 73.1% for infective endocarditis and 35.2% for pulmonary embolism. Conclusion: Age and hospital ward influenced the distribution of diagnostic discrepancy or concordance between clinical and autopsy diagnoses. The lower discrepancy rate for myocardial infarction and infective endocarditis may be related to the fact that the study was carried out in a specialist hospital.