Coronary disease & ACSCohort study
Causes of Myocardial Infarction in Younger Patients
- Retrospective cohort study
- community-based
- adjudicated MI mechanism
Records and imaging individually scrutinized; mechanism adjudicated
Authors' conclusion
This community-based study demonstrates nonatherothrombotic causes comprise an important burden of acute MI in persons age ≤65 years, particularly women.
Study context
- Population
- Olmsted County, Minnesota, US residents aged ≤65 years with troponin T >99th percentile (≥0.01 ng/mL), January 2003 to March 20184,116 injury events
- Participants
- 2,780 participants
- Exposure
- Women vs men; MI by pathophysiologic mechanism
- Outcome
- Incidence of MI by pathophysiologic mechanism (atherothrombosis, SCAD, embolism, vasospasm, MINOCA-U, supply/demand mismatch secondary MI) and sex differences in etiology
Main finding
As reported in the abstract
MI incidence and etiology by sex
Atherothrombosis share
SSDM share
SCAD share
Embolism share
Vasospasm share
MINOCA-U share
| Outcome | Women | Men |
|---|---|---|
| MI incidence | 48 per 100,000 person years | 137 per 100,000 person years |
| Atherothrombotic MI incidence | 23 per 100,000 person-years | 105 per 100,000 person-years |
| SCAD incidence | 3.2 per 100,000 person-years | 0.9 per 100,000 person-years |
- Index MI caused by atherothrombosis (overall)
- 68%
Observational data: associations, not effects.
Further findings
Age with atherothrombotic MI
Spontaneous coronary artery dissection (SCAD) misclassified as MINOCA or atherothrombosis at index presentation
- SCAD cases misclassified
- 55%
Age with atherothrombotic MI
- Similar disease extent at angiography; greater risk-factor burden in women
5-year all-cause mortality by mechanism
- SSDM
- 33%
- Atherothrombosis
- 8%
- Embolism
- 8%
- SCAD
- 0%
- Low CV mortality in all groups
Original publication
Causes of Myocardial Infarction in Younger Patients. J Am Coll Cardiol. Published 27 August 2025. doi:10.1016/j.jacc.2025.07.012
Summarised from the published abstract; every number is checked against it