Acute myocardial infarction in the young: A 3-year retrospective study.

Abstract

Background: Acute myocardial infarction (AMI) is rare among patients aged ≤ 40 years but imposes significant morbidity, psychological distress, and economic burden. Approximately 10% of AMI hospitalizations involve patients under 45 years, underscoring the need to study this group. Compared to older patients, young AMI patients exhibit fewer traditional risk factors (e.g., hypertension, diabetes) but higher rates of smoking, obesity, and non-atherosclerotic causes like spontaneous coronary artery dissection or coronary spasm, often linked to substance use. Global trends show rising obesity and dyslipidemia in young populations, with smoking contributing to 62%-90% of AMI cases in this age group. Family history of coronary artery disease also elevates risk, particularly in acute coronary syndrome. Studies like Bhardwaj et al report that young AMI patients are predominantly male with single-vessel disease, unlike the multi-vessel disease typical in older cohorts. This study characterizes AMI in young adults (≤ 40 years) at a single center, focusing on presentation, risk factors, angiographic findings, and management to guide preventive strategies.

Aim: To describe the characteristics of AMI in young patients, including presentation, risk factors, coronary angiography (CAG) findings, and management strategies.

Methods: This retrospective cross-sectional study analyzed 91 patients aged 20-40 years diagnosed with AMI at Mouwasat Hospital Dammam, from June 2020 to May 2023. Data on clinical presentation, cardiovascular risk factors, CAG findings, and treatments were collected from medical records. Descriptive statistics were used to summarize findings.

Results: Of 91 patients (96.7% male, mean age 35.9 years ± 3.4 years), 43.9% were obese (body mass index > 30 kg/m²). Hyperlipidemia was the most prevalent risk factor (69.2%), followed by smoking (49.5%), diabetes mellitus (33.0%), and hypertension (26.4%). ST-elevation myocardial infarction (STEMI) was the most common presentation (57.1%). The left anterior descending artery was frequently affected (78.0%), with single-vessel disease predominant (72.5%). Most patients underwent percutaneous coronary intervention (PCI) (74.7%), while 8.8% required surgery.

Conclusion: Young AMI patients are predominantly obese males with hyperlipidemia and smoking as key risk factors, presenting with STEMI and single-vessel disease amenable to PCI.