Causes, Angiographic Characteristics, and Management of Premature Myocardial Infarction: JACC State-of-the-Art Review

J Am Coll Cardiol. 2022 Jun 21;79(24):2431-2449. doi: 10.1016/j.jacc.2022.04.015.


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.

Keywords: MINOCA; SCAD; cocaine; premature myocardial infarction; smoking.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coronary Angiography / adverse effects
  • Coronary Artery Disease*
  • Coronary Vessel Anomalies* / complications
  • Coronary Vessels / pathology
  • Female
  • Humans
  • Myocardial Infarction* / diagnostic imaging
  • Myocardial Infarction* / epidemiology
  • Risk Factors