Causes, Angiographic Characteristics, and Management of Premature Myocardial Infarction

Highlights

• Approximately 1 in 8 patients with premature myocardial infarction has MINOCA, which may be associated with use of recreational drugs, particularly cocaine.

• Spontaneous coronary artery dissection is an important cause of premature myocardial infarction in women, especially in the peripartum period.

• The most powerful secondary preventive measure for patients with premature myocardial infarction is smoking cessation.

Abstract

Among patients presenting with acute myocardial infarction (AMI), the proportion of young individuals has increased in recent years. Although coronary atherosclerosis is less extensive in young patients with AMI, with higher prevalence of single-vessel disease and rare left main involvement, the long-term prognosis is not benign. Young patients with AMI with obstructive coronary artery disease have similar risk factors as older patients except for higher prevalence of smoking, lipid disorders, and family history of premature coronary artery disease, and lower prevalence of diabetes mellitus and hypertension. Smoking cessation is by far the most effective secondary preventive measure. Myocardial infarction with nonobstructive coronary arteries is a relatively common clinical entity (10%-20%) among young patients with AMI, with intravascular and cardiac magnetic resonance imaging being key for diagnosis and potentially treatment. Spontaneous coronary artery dissection is a frequent pathogenetic mechanism of AMI among young women, requiring a high degree of suspicion, especially in the peripartum period.