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Patients with prior acute myocardial infarction (AMI) generally show low rates of achieving secondary prevention targets. Here we evaluated adherence to guideline-recommended secondary prevention strategies after AMI in Saudi Arabia. This ambispective multicenter cohort study included consecutive patients seen for follow-up visits 6-24 months after hospitalization for AMI. A standardized questionnaire was used to evaluate control of blood pressure (<130/80 mmHg), HbA1c (<7%), LDL-C (<1.4 mmol/L), lipoprotein(a) (<50 mg/dL), body mass index (18.5-24.9 kg/m²), physical activity targets, smoking habits, guideline-directed medical therapy (GDMT), and referral to cardiac rehabilitation. Among 108 AMI patients (mean age 58.4 ± 10.9 years; 80.6% male; 76.9% Saudi nationals), 53.7% had uncontrolled blood pressure, ~40% uncontrolled glucose, and 67% above-target LDL-C levels. Most participants were overweight (40.7%) or obese (37%), and 28.7% achieved the physical activity targets. One-third of patients were not receiving all GDMT, 15.7% were current smokers, and 25% had been referred to cardiac rehabilitation. No patient met all guideline-recommended secondary prevention targets. This pilot study highlights gaps in secondary prevention among AMI survivors. Upcoming study phases will aim for national representation and help identify key clinical and demographic drivers to improve secondary prevention efforts across Saudi Arabia.