Clinical and Biochemical Assessment of First Acute Myocardial Infarction in Older Patients: A Tertiary Care Hospital Experience

Background: Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide, with adults aged ≥50 years constituting a high-risk group due to clustering of cardiovascular risk factors and metabolic–inflammatory burden. Data specifically characterizing first AMI in this age group, particularly extended biochemical markers, are limited. Methods & Materials: This cross-sectional observational study was conducted from July 2022 to December 2023 in four tertiary cardiac centers in Dhaka, Bangladesh. Eighty consecutively admitted patients aged ≥50 years with first-ever AMI (STEMI or NSTEMI), diagnosed by standard clinical, ECG, and troponin criteria, were included. Socio-demographic data, cardiovascular risk factors, clinical features, ECG and echocardiographic findings were recorded. Results: Of the 80 patients, 65 (81.3%) were male. Hypertension (75.0%), diabetes mellitus (52.5%), dyslipidemia (51.3%), and smoking (43.8%) were common. Chest pain was the predominant symptom (73.8%). NSTEMI slightly exceeded STEMI (53.8% vs. 46.3%). Left ventricular systolic dysfunction (LVEF <50%) was present in 80.0% of patients. Biochemical findings showed elevated fasting glucose, troponin-I, CRP, an atherogenic lipid profile, and suboptimal median serum vitamin D (28 ng/mL). Multivariable analysis identified hypertension (adjusted OR 26.62), diabetes mellitus (adjusted OR 12.69), and low serum vitamin D level (adjusted OR 1.11 per unit) as independent predictors (p<0.001). Conclusion: First AMI in patients aged ≥50 years was associated with a high burden of modifiable risk factors and vitamin D insufficiency, underscoring the need for intensified primary prevention strategies.