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