Acute Myocardial Infarction in Young Adults: A Systematic Review of Epidemiology, Risk Factors, Clinical Features, Management, and Outcomes

Abstract

Background: Acute myocardial infarction in young adults is an increasingly important cardiovascular condition with substantial clinical, psychosocial and socioeconomic implications. Although traditionally associated with older age, premature coronary artery disease is reported among younger populations and may reflect both conventional and non-conventional risk profiles. Objective: This systematic review summarises evidence on the epidemiology, risk factors, pathophysiology, clinical presentation, angiographic findings, management and outcomes of myocardial infarction in young adults. Materials and Methods: A literature search was conducted using PubMed, Scopus, Web of Science and Google Scholar. Eligible evidence included observational studies, registry studies, case-control studies, systematic reviews and meta-analyses published in English. Studies involving young adults with acute myocardial infarction were reviewed, and findings were synthesised narratively according to PRISMA principles. Results: Smoking was the most consistently reported cardiovascular risk factor. Dyslipidaemia, obesity, diabetes mellitus, hypertension, sedentary lifestyle, psychosocial stress and family history were also frequent. Young adults commonly presented with ST-segment elevation myocardial infarction and single-vessel coronary artery disease, often involving the left anterior descending artery. Non-atherosclerotic mechanisms, including spontaneous coronary artery dissection, MINOCA, thrombophilia, coronary vasospasm, congenital coronary anomalies and substance abuse, were clinically relevant in this population. Although short-term mortality was generally lower than in older adults, recurrent cardiovascular events and psychosocial consequences remained important. Conclusion: Myocardial infarction in young adults is multifactorial. Prevention, risk factor modification, psychosocial support, cardiac rehabilitation and long-term secondary prevention are central to reducing disease burden.