Clinical features of myocardial infarction in young patients. Part 1. The structure of risk factors, pathogenesis and clinical presentation

Objective. To study the features of the clinical course, the risk factors, and the pathogenesis of myocardial infarction with and without coronary artery obstruction in young patients. Materials and methods. 105 young patients with MI were studied. Patients were divided into 2 groups: the first group included patients with MI with obstructive coronary artery (MIOCA) and the second group included patients with nonobstructive coronary arteries (MINOCA). Stress as a MI risk factor was assessed using the L. Reeder test. Alcohol abuse was assessed by the presence of chronic alcohol intoxication stigmas, CAGE (Cut down, Annoyed, Guilty, Eye-opener), and PAI (post-intoxication alcohol syndrome) questionnaire. Patients’ eating habits and physical activity were analyzed. The time from the onset of MI to seeking medical care was determined. Results. The main non-modifiable risk factor for MI in young patients is male gender. The main modifiable risk factor is smoking. The development of MIOCA is characterized by classic risk factors, including low physical activity, insufficient consumption of vegetables and fruits, a family history of cardiovascular disease, and arterial hypertension. Patients with MINOCA more typically had specific risk factors, including the consumption of energy drinks, addictive substances, and stress. In MIOCA patients, the classic presentation of MI with a typical retrosternal pain was observed. MINOCA patients had more non-typical MI symptoms, including epigastric pain, nausea, vomiting, weakness, and dizziness. MINOCA patients tend to seek medical help late. Conclusions. Young patients with myocardial infarction with and without obstructive coronary artery disease had different risk factors and clinical presentations presentation. In myocardial infarction without coronary artery obstruction, specific risk factors, non-typical symptoms, and delay in seeking medical care were more common.