Myocardial Infarction in the "Young'': Risk Factors, Presentation, Management and Prognosis

Myocardial infarction (MI) in the "young'' is a significant problem, however there is scarcity of data on premature coronary heart disease (CHD) and MI in the "young''. This may lead to under-appreciation of important differences that exist between "young'' MI patients versus an older cohort. Traditional differences described in the risk factor profile of younger MI compared to older patients include a higher prevalence of smoking, family history of premature CHD and male gender. Recently, other potentially important differences have been described. Most "young'' MI patients will present with non-ST elevation MI but the proportion presenting with ST-elevation MI is increasing. Coronary angiography usually reveals less extensive disease in "young'' MI patients, which has implications for management. Short-term prognosis of "young'' MI patients is better than for older patients, however contemporary data raises concerns regarding longer-term outcomes, particularly in those with reduced left ventricular systolic function. Here we review the differences in rate, risk factor profile, presentation, management and prognosis between "young'' and older MI patients.