The following are key points to remember from this state-of-the-art review on angiographic characteristics and management of premature myocardial infarction (MI):

1. Among patients presenting with acute myocardial infarction (AMI), the proportion of young individuals or premature AMI has increased in recent years.
2. It is estimated that >1 million hospital admissions from 2001–2010 in the United States were due to AMI in 30- to 50-year-old patients.
3. Although coronary atherosclerosis is less extensive in young patients with AMI, with higher prevalence of single-vessel disease and rare left main involvement, the long-term prognosis is not benign.
4. In general, young patients with AMI with obstructive coronary artery disease (CAD) have similar risk factors as older patients except for higher prevalence of smoking, lipid disorders, and family history of premature CAD, and lower prevalence of diabetes mellitus and hypertension.
5. In obstructive CAD and premature AMI, medical therapy and revascularization strategies follow the same rules as for older patients.
6. Smoking cessation or abstinence from tobacco use is the most effective secondary preventive measure among young individuals and associated with an approximately 70-80% lower rate of all-cause and cardiovascular mortality compared with continued smoking at 1 year after AMI.
7. Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a relatively common clinical entity (10-20%) among young patients with AMI, with intravascular and cardiac magnetic resonance imaging being key for diagnosis and potentially treatment.
8. Furthermore, MINOCA may be associated with use of recreational drugs, particularly cocaine.
9. Spontaneous coronary artery dissection is a frequent pathogenetic mechanism of AMI among young women, requiring a high degree of clinical suspicion, especially in the peripartum period.
10. Of note, premature AMI, particularly in the setting of obstructive CAD and/or female sex, is an aggressive disease with high rates of recurrence and mortality, attributed largely to suboptimal control of modifiable risk factors, highlighting the importance of appropriate guideline-directed secondary preventive therapies.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Lipid Metabolism, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging, Hypertension, Smoking

Keywords: Acute Coronary Syndrome, Angiography, Atherosclerosis, Cocaine, Coronary Artery Disease, Diabetes Mellitus, Diagnostic Imaging, Hypertension, Lipids, Magnetic Resonance Imaging, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Peripartum Period, Primary Prevention, Risk Factors, Secondary Prevention, Smoking, Smoking Cessation, Tobacco Smoking

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