Look Carefully for Causes of Myocardial Infarction in Younger Patients

Clinical Takeaway

: In patients 65 years of age and younger, nonatherosclerotic causes of MI are common, especially in women.

Context

To determine the incidence and causes of myocardial infarctions (MI) in a community-based cohort of individuals ≤65 years from Olmsted County, Minnesota, investigators identified myocardial injury events (cardiac troponin T >99th percentile of upper reference range) over a 15-year period (2003–2018). They adjudicated 1474 cases meeting criteria for spontaneous MI into 1 of 6 pathophysiologic categories based on mechanism.

Key Results

Pathophysiologic classifications were: 67% atherothrombosis, 23% supply-demand mismatch (SSDM), 4% spontaneous coronary artery dissection (SCAD), 2% embolism, 1% vasospasm, and 3% myocardial infarction with nonobstructed coronary arteries (MINOCA).
MI caused by atherothrombosis was significantly less common…

Reviewing Author

Karol E. Watson, MD, PhD, FACC

Disclosures

Consultant/Advisory BoardBoehringer Ingelheim; Amgen; Novartis; Lilly; Amarin

Speaker’s BureauBoehringer Ingelheim

Grant/Research SupportNIH

Editorial BoardsCirculation (Associate Editor)