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Observational Study
. 2024 Oct;13(19):e034456.
doi: 10.1161/JAHA.124.034456. Epub 2024 Sep 25.

Characteristics of Young Women Presenting With Acute Myocardial Infarction: The Prospective, Multicenter, Observational Young Women Presenting Acute Myocardial Infarction in France Study

Stéphane Manzo-Silberman  1 , Francis Couturaud  2 , Anne Bellemain-Appaix  3   4 , Estelle Vautrin  5 , Anne Gompel  6 , Ludovic Drouet  7 , Stephanie Marliere  5 , Claire Bal Dit Sollier  7 , Sabrina Uhry  8 , Hélène Eltchaninoff  9 , Tessa Bergot  10 , Pascal Motreff  11 , Najiba Lahlou  12 , Yves Cottin  13 , Claire Mounier-Vehier  14 , Martine Gilard  2 , Gilles Montalescot  4 ; WAMIF Investigators
Affiliations
Observational Study

Characteristics of Young Women Presenting With Acute Myocardial Infarction: The Prospective, Multicenter, Observational Young Women Presenting Acute Myocardial Infarction in France Study

Stéphane Manzo-Silberman et al. J Am Heart Assoc. 2024 Oct.

Abstract

Background: The percentage of women <50 years of age hospitalized with myocardial infarction is increasing. We describe the clinical, morphological, and biological characteristics, as well as the clinical outcomes of this population.

Methods and results: This prospective, observational study included consecutive women <50 years of age admitted for myocardial infarction at 30 centers in France (May 2017-June 2019). The primary outcome was the composite of net adverse clinical events: all-cause death, cardiovascular death, recurrent myocardial infarction, stent thrombosis, any stroke, or major bleeding occurring during hospitalization with a 12-month follow up. Three hundred fourteen women were included. The mean age was 43.0 (±5.7) years, 60.8% presented with ST-segment-elevation myocardial infarction, 75.5% were current smokers, 31.2% had a history of complicated pregnancy, and 55.1% reported recent emotional stress. Most (91.6%) women presented with typical chest pain. Of patients on an estrogen-containing contraceptive, 86.0% had at least 1 contraindication. Of patients with ST-segment-elevation myocardial infarction, 17.8% had myocardial infarction with nonobstructive coronary arteries and 14.6% had spontaneous coronary artery dissection, whereas 29.3% presented with multivessel vessel disease. During hospitalization, 11 net adverse clinical events occurred in 9 (2.8%) women, but no deaths or stent thromboses occurred. By 12 months, 14 net adverse clinical events occurred in 10 (3.2%) women; 2 (0.6%) died (from progressive cancer) and 25 (7.9%) had an ischemia-driven repeat percutaneous coronary intervention.

Conclusions: Most young women with myocardial infarction reported typical chest pain and had modifiable cardiovascular risk factors. History of adverse pregnancy outcomes and prescription of combined oral contraceptive despite a contraindication were prevalent, emphasizing the need for comprehensive cardiological and gynecological evaluation and follow-up.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03073447.

Keywords: acute coronary syndrome; cardiovascular risk; coronary artery disease; myocardial infarction; women.

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Figures

Figure 1
Figure 1. Flowchart.
CABG indicates coronary artery bypass graft; NSTEMI, non–ST‐segment–elevation myocardial infarction; PCI, percutaneous coronary intervention; SCAD, spontaneous coronary artery dissection; STEMI, ST‐segment–elevation myocardial infarction; and WAMIF, Young Women Presenting Acute Myocardial Infarction in France
Figure 2
Figure 2. Cumulative incidence of first NACE in women.
Between the brackets are reported pointwise 95% CIs. NACE indicates net adverse clinical events; NSTEMI, non‐ST‐segment elevation myocardial infarction; and STEMI, ST‐segment elevation myocardial infarction.
Figure 3
Figure 3. WAMIF study main results.
AMI indicates acute myocardial infarction; MINOCA, myocardial infarction with nonobstructive coronary arteries; NACE, net adverse clinical events; SCAD, spontaneous coronary artery dissection; and WAMIF, Young Women Presenting Acute Myocardial Infarction in France
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