Myocardial Infarction in the “Young”: Risk Factors, Presentation, Management and Prognosis

Abstract

Myocardial infarction (MI) in the "young" is a significant problem, however there is scarcity of data on premature coronary heart disease (CHD) and MI in the "young". This may lead to under-appreciation of important differences that exist between "young" MI patients versus an older cohort. Traditional differences described in the risk factor profile of younger MI compared to older patients include a higher prevalence of smoking, family history of premature CHD and male gender. Recently, other potentially important differences have been described. Most "young" MI patients will present with non-ST elevation MI but the proportion presenting with ST-elevation MI is increasing. Coronary angiography usually reveals less extensive disease in "young" MI patients, which has implications for management. Short-term prognosis of "young" MI patients is better than for older patients, however contemporary data raises concerns regarding longer-term outcomes, particularly in those with reduced left ventricular systolic function. Here we review the differences in rate, risk factor profile, presentation, management and prognosis between "young" and older MI patients.

Risk factors of premature coronary artery disease in Iran: A systematic review and meta‐analysis

“…Obesity is significantly associated with increased risk of PCAD and is considered an independent risk factor for coronary atherosclerosis . In Puerto Rico, a study of young patients (under 35 years of age), presenting with myocardial infarction, showed that obese patients had a 5.94 times higher probability for obstructive coronary disease than normal‐weight patients.…”

“…61 In the United States, recently, hypertension found to be associated with increased risk for PCAD with an adjusted OR = 1.8, but this ratio raised to 4 if patients were already on hypertension treatment, a strange finding probably referring to severe cases of hypertension. 51 Obesity is significantly associated with increased risk of PCAD 62,63 and is considered an independent risk factor for coronary atherosclerosis. 64 In Puerto Rico, a study of young patients (under 35 years of age), presenting with myocardial infarction, showed that obese patients had a 5.94 times higher probability for obstructive coronary disease than normal-weight patients 62 .…”

Adherence to guidelines for pharmacological treatment of young adults with myocardial infarction in Poland: Data from Polish Registry of Acute Coronary Syndromes (PL‐ACS)

“…3 Additionally, the readmission after MI is frequent among young patients, reaching almost 10% in a 30-day follow-up period. 3 Additionally, the readmission after MI is frequent among young patients, reaching almost 10% in a 30-day follow-up period.…”

Comparison of In-hospital Outcomes of Percutaneous Coronary Intervention between Young Male and Female Patients with Acute Coronary Syndrome

“…[2][3][4] As cardiovascular disease develops 7 to 10 years later in women than in men, 5 chiefly owing to the protective effect of endogenous estrogens in young females, the definition of "young" patients in relation to ACS differs for each gender. As such, we defined young females as <55 years of age, and young males <45 years of age in this study, in accordance with a consensus derived from the literature.…”

“…7 The management of MI is not dependent on age, and guideline-suggested therapies are just as applicable to younger patients as they are to older counterparts. 2,8,9 Although percutaneous revascularization is generally considered to be associated with lower risk and better recovery in young patients, some studies have observed that younger women were more likely than men to experience adverse in-hospital outcomes, including major adverse cardiac events (MACE), peri-procedural complications and especially bleeding, despite similarly high angiographic and procedural success. [10][11][12][13] Alternatively, a few studies have observed higher MACE among young males undergoing PCI.…”