Causes of Myocardial Infarction in Younger Patients: Troponin-Elevation in Persons ≤65 Years Old in Olmsted County
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
Methodological detailscommunity-based, adjudicated MI mechanism, Records and imaging individually scrutinized; mechanism adjudicated
- Community-based
- Adjudicated MI mechanism
- Records and imaging individually scrutinized; mechanism adjudicated
Main finding
As reported in the abstract
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: Troponin-Elevation in Persons ≤65 Years Old in Olmsted County. J Am Coll Cardiol. Published 27 August 2025. doi:10.
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