Acute respiratory infections, including influenza, have been suggested as possible precipitants of acute cardiac events. To evaluate whether influenza vaccination prevents recurrent coronary events, the authors conducted a population-based inception cohort study of 1,378 Group Health Cooperative enrollees who survived a first myocardial infarction in 1992 through 1996. Recurrent coronary events, influenza vaccinations, and other covariates were identified by chart review and from administrative data systems. A Cox proportional hazards model was used to evaluate the association of receipt of each year's influenza vaccine with subsequent risk of recurrent myocardial infarction and death from atherosclerotic cardiovascular disease. A total of 127 recurrent coronary events were identified during the median 2.3-year follow-up period. Influenza vaccination was not associated with risk of recurrent coronary events during the corresponding period of November through October (adjusted hazard ratio (HR) = 1.18, 95% confidence interval (CI): 0.79, 1.75) or during the corresponding periods of expected influenza activity (November through April) (HR = 1.06, 95% CI: 0.63, 1.78) or inactivity (May through October) (HR = 1.34, 95% CI: 0.76, 2.36). These results suggest that the benefit of influenza vaccine for older adults does not extend to protection against recurrent coronary events.