Myocardial infarction (MI) remains a critical emergency with an increasing incidence among young women exposed to various risk factors. Despite extensive data on MI, limited information exists on premature coronary artery disease in women under 50 years.

This single-center retrospective study included women hospitalized for MI evaluation between July 2019 and December 2021. Patients were divided into two groups: women under 50 (young women) and those aged 50 and above. Clinical, paraclinical, and angiographic characteristics, as well as outcomes, were compared.

Among 197 women, 44 were under 50 years, with a mean age of 44 ± 6 years. Key cardiovascular (CV) risk factors included smoking (46%), hypertension (53%), diabetes (44%), and family history of coronary artery disease (21%). Autoimmune disease was present in 11%. ST-elevation myocardial infarction (STEMI) was observed in 34%, with 47% presenting late (>12 hours). Monovessel disease affected 57%, with the left anterior descending artery most commonly involved (55%). Atherosclerosis was the leading etiology (66%), followed by spontaneous coronary artery dissection (SCAD) (16%). Young women had fewer overall CV risk factors but higher rates of smoking, familial coronary history, and autoimmune disease. They presented more frequently with non-ST elevation myocardial infarction (NSTEMI), SCAD, and monovessel disease, requiring less revascularization. In-hospital follow-up revealed fewer major cardiac and cerebrovascular events (MACCE) and no deaths among young women. Long-term follow-up showed lower MACCE incidence (11% vs. 32.7%) and similar low mortality rates. Event-free survival was longer in young women (91.3 vs. 65.5 months).

Conclusions: 
MI incidence in young women is rising. Smoking and hypertension are key risk factors. Despite fewer complications, long-term follow-up highlights the need for targeted prevention strategies.

Fekher Jaoued is a 30 years old cardiologist specializing in interventional cardiology at Mongi Slim Hospital in Tunisia. A dedicated clinician and researcher, he has authored three publications that contribute to the advancement of cardiovascular medicine. With a passion for innovation in cardiac care, he is committed to improving outcomes for patients through both his clinical expertise and ongoing research efforts.