Tudurachi Bogdan-Sorin, Anghel Larisa, Tudurachi Andreea, Zanfirescu Răzvan-Liviu, Bîrgoan Silviu-Gabriel, Sascău Radu Andy, Stătescu Cristian
Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania.
Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania.
Biomolecules. 2025 Jul 23;15(8):1065. doi: 10.3390/biom15081065.
Acute myocardial infarction (AMI) in young adults, though less common than in older populations, is an emerging clinical concern with increasing incidence and diverse etiologies. Unlike classic atherosclerotic presentations, a significant proportion of AMI cases in individuals under 45 years are due to nonatherothrombotic mechanisms such as coronary vasospasm, spontaneous coronary artery dissection (SCAD), vasculitis, hypercoagulable states, and drug-induced coronary injury. This manuscript aims to explore the multifactorial nature of AMI in young adults through a focused review of current evidence and a series of illustrative clinical cases. We present and analyze four distinct cases of young patients with AMI, each demonstrating different pathophysiological mechanisms and risk profiles-including premature atherosclerosis, substance use, human immunodeficiency virus (HIV)-related coronary disease, and SCAD. Despite the heterogeneity of underlying causes, early diagnosis, individualized management, and aggressive secondary prevention were key to favorable outcomes. Advanced imaging, lipid profiling, and risk factor modification played a central role in guiding therapy. AMI in young adults requires heightened clinical suspicion and a comprehensive, multidisciplinary approach. Early intervention and recognition of nontraditional risk factors are essential to improving outcomes and preventing recurrent events in this vulnerable population.
年轻成人急性心肌梗死（AMI）虽然不如老年人群中常见，但随着发病率上升和病因多样，已成为一个新出现的临床关注点。与典型的动脉粥样硬化表现不同，45岁以下个体中相当一部分AMI病例是由非动脉粥样硬化血栓形成机制引起的，如冠状动脉痉挛、自发性冠状动脉夹层（SCAD）、血管炎、高凝状态和药物性冠状动脉损伤。本手稿旨在通过重点回顾当前证据和一系列典型临床病例，探讨年轻成人AMI的多因素性质。我们展示并分析了4例年轻的AMI患者，每例都表现出不同的病理生理机制和风险特征，包括早发性动脉粥样硬化、物质使用、人类免疫缺陷病毒（HIV）相关冠状动脉疾病和SCAD。尽管潜在病因存在异质性，但早期诊断、个体化管理和积极的二级预防是取得良好预后的关键。先进的影像学检查、血脂分析和风险因素调整在指导治疗中发挥了核心作用。年轻成人AMI需要提高临床怀疑度并采取全面的多学科方法。早期干预和识别非传统风险因素对于改善这一脆弱人群的预后和预防复发事件至关重要。
