Causes Of Myocardial Infarction In Younger Patients Claire E Raphael Mbbs Phd Yader Sandoval Md Joel D Beachey Md Veronique Roger Md Mph Mandeep Singh Md Matthew P Johnson Msc Marysia S Tweet Md Ms Malcolm R Bell Md Amir Lerman Md Sharonne N Hayes Md David R Holmes Md by Claire E. Raphael Mbbs Phd & Yader Sandoval Md & Joel D. Beachey Md & Veronique Roger Md Mph & Mandeep Singh Md & Matthew P. Johnson Msc & Marysia S. Tweet Md Ms & Malcolm R. Bell Md & Amir Lerman Md & Sharonne N. Hayes Md & David R. Holmes Md &... instant download after payment.

BACKGROUND The burden and pathophysiologic mechanisms of myocardial infarction (MI) in younger patients remainunderstudied. Prior studies have been limited by selected cohorts and lack of awareness of nonatherothrombotic causes.OBJECTIVES We sought to determine the incidence and outcomes of MI according to a unique pathophysiologicmechanism in a large community cohort aged #65 years, and to evaluate sex-differences in etiologyMETHODS We identified all residents of Olmsted County, Minnesota, USA, age #65 years who experienced an eventassociated with a cardiac troponin T >99th percentile of upper reference range ($0.01 ng/mL) from January 2003 toMarch 2018. Records and imaging were individually scrutinized. Patients classified as MI were assigned to 1 of 6 adjudicated pathophysiologic mechanisms: atherothrombosis, spontaneous coronary artery dissection (SCAD), embolism,vasospasm, myocardial infarction with nonobstructed coronary arteries not meeting another category (MINOCA-U), andsupply/demand mismatch secondary myocardial infarction. We determined incidence and long-term all-cause and cardiovascular mortality for each group.RESULTS There were 4,116 myocardial injury events in 2,780 patients (36% women) over 15 years. Excluding periprocedural MI, 1,474 events were classified as index MI, of which 68% were caused by atherothrombosis. The populationincidence of MI was much lower in women, particularly in MI caused by atherothrombosis (48 vs 137 per 100,000 personyears and 23 vs 105 per 100,000 person-years). Incidence of SCAD was much higher in women (3.2 vs 0.9 per 100,000person-years) with 55% of cases misclassified as MINOCA or atherothrombosis at index presentation. Women withatherothrombosis were similar in age to men (55 ± 8 years vs 54 ± 8 years), with similar disease extent at angiographybut greater burden of risk factors. Proportionately, nonatherothrombotic cause