Myocardial infarction: rising in-hospital mortality, particularly among women

By Elodie Vaz | Published on March 6, 2026 | 3 min read


Myocardial infarction remains a major cause of cardiovascular mortality. It occurs when a coronary artery becomes obstructed, leading to ischemia and then myocardial necrosis. Two main clinical subtypes dominate acute management: ST-segment elevation myocardial infarction (STEMI), generally related to complete occlusion, and non–ST-segment elevation myocardial infarction (NSTEMI), associated with partial obstruction.  

Long considered a condition predominantly affecting older adults, myocardial infarction also affects younger adults. This reality is at the center of a study published on February 26 in a special “Go Red for Women” issue of the Journal of the American Heart Association, the American Heart Association’s open-access scientific journal. This issue is part of the Go Red for Women initiative, launched in 2004 to improve the prevention and management of cardiovascular disease in women.  

The aim was to assess recent trends in in-hospital mortality after a first myocardial infarction among U.S. adults aged 18 to 54, and to examine potential disparities by sex and infarction subtype.  

“These results are surprising and concerning,” said Dr. Mohan Satish in a press release. He is the study’s lead author, a clinician specializing in cardiovascular disease, and a postdoctoral fellow at NewYork-Presbyterian/Weill Cornell Medical Center in New York.  

He recalled the prior epidemiologic context. “Based on observational studies conducted up to 2010, the number of deaths from heart attacks in the United States appeared to have stabilized or even decreased. However, that decline seems to have been driven mainly by older adults and men.” He added: “Heart attacks are often thought to affect primarily older people; yet our results indicate that young adults, and especially women, are also at real risk.”  

Nearly one million hospitalizations analyzed  

The analysis is based on nearly one million hospitalizations recorded between 2011 and 2022 among patients aged 18 to 54 admitted for a first myocardial infarction.

Researchers distinguished STEMI from NSTEMI and adjusted their analyses for patient and hospital characteristics. The study focused on in-hospital mortality and complications occurring during the stay, without long-term follow-up after discharge.  

Excess female mortality  

Overall, in-hospital mortality after a first STEMI increased significantly over the study period, with an absolute rise of 1.2%. By contrast, mortality rates for NSTEMI remained stable.

A clear disparity emerged by sex. After a first STEMI, in-hospital mortality was 3.1% in women versus 2.6% in men. For NSTEMI, it reached 1% in women, compared with less than 1% in men.  

Fewer interventions, more non-traditional risk factors

Notably, women had in-hospital complication rates similar to those of men, but underwent fewer cardiovascular interventions aimed at identifying and treating the cause of the infarction.  

In addition, the youngest women were more likely to have non-traditional risk factors. Across both sexes, after adjustment for the factors studied, determinants such as low income, kidney disease, or the use of drugs other than tobacco were more strongly associated with in-hospital death than traditional cardiovascular risk factors.  

Limitations and perspectives  

This study highlights a concerning increase in in-hospital mortality after a first STEMI among adults under 55, with an excess risk among women. It also underscores the weight of non-traditional risk factors in acute prognosis.  

“To improve the management of heart attacks in adults under 55, especially women, it is essential to identify risk factors earlier and to take non-traditional risk factors into account in order to optimize treatments,” said Professor Satish. “Future studies will need to examine how non-traditional risk factors influence heart attack risk, in addition to their impact on traditional risk factors.”  

The authors nonetheless note several limitations, including the use of administrative data that may be subject to coding errors and the absence of post-hospital follow-up.

These results call for rethinking risk stratification in young adults and for more systematic integration of social and non-traditional clinical determinants into prevention and care strategies—particularly for women, whose cardiovascular risk remains underestimated.  

Read next: Hypertension: a new threshold, a new challenge

About the Author – Elodie Vaz
Health journalist, CFPJ graduate (2023).
Élodie explores the marks diseases leave on bodies and, more broadly, on human life. A registered nurse since 2010, she spent twelve years at patients’ bedsides before exchanging her stethoscope for a notebook. She now investigates the links between environment and health, convinced that the vitality of life cannot be reduced to that of humans alone.