CONCLUSIONS
The present study results indicate that recent influenza and other acute respiratory illnesses may commonly occur prior to onset of AMI among Bangladeshi patients. Additionally, the study has generated some data regarding the relationship between recent respiratory illness and influenza with severity of myocardial infarction across different study seasons in Bangladesh which, however, were statistically not significant. Nevertheless, our results emphasize the importance of increased awareness among patients with heart conditions as well as among healthcare providers in Bangladesh about the possible risk of seasonal outbreaks of influenza and other acute respiratory illnesses. This may lead to improved timeliness of early interventions and hence better patient outcomes. Our results indicate the need for further studies, using prospective cohort or case-control design, and in particular conducted over multiple seasons and multiple centers across the country to investigate the association between recent respiratory illness and influenza with onset of AMI in Bangladeshi context. Given the known high prevalence of both acute cardiovascular events like AMI as well as seasonal influenza (27) in Bangladesh, and potential efficacy of influenza vaccination against incidence of AMI, as revealed through recently completed large scale clinical trial (22) and other observational studies, benefits of influenza vaccination program as well as infection prevention and control practices in Bangladesh deserve further exploration. Our study may provide valuable insights about the latent risk of acute respiratory illness and influenza for cardiovascular patients in Bangladesh, but our results should be cautiously considered in the context of their limitations and potential biases.