Myocardial infarction with no obstructive coronary arteries (MINOCA) in young patients

The incidence of myocardial infarction (MI) is declining in many countries around the world; however, in patients under 45 years old, an increase in MI incidence is observed. The reasons for this trend are changes in the lifestyle of young people, the "rejuvenation" of traditional risk factors, as well as the emergence of specific risk factors for MI. Currently, according to coronary angiography data, MI is usually divided into MI with coronary artery obstruction (MIOCA) and MI without coronary artery obstruction (MINOCA). These types of myocardial infarction differ in their risk factors, pathogenesis, and clinical course. MIOCA is characterized by classic MI risk factors: high blood pressure, diabetes, excess body weight, physical inactivity, and a family history of cardiovascular disease. In MINOCA, specific risk factors for myocardial infarction are more common: stress, consumption of energy drinks, narcotic substances, alcohol abuse, and hereditary thrombophilia. The article presents the definition, main pathogenetic mechanisms, clinical presentation, prognosis, and clinical cases of MINOCA in young patients who did not have classical risk factors for MI, but were diagnosed with elevated stress levels, alcohol abuse, excessive consumption of caffeinated beverages, and hereditary thrombophilia. All patients had predictors of SCD, which may be related to alcohol abuse, chronic stress, large areas of necrosis in myocardium unprepared for ischemia, late diagnosis, and lack of pathogenetic treatment for MI. Without risk factors modification and pathogenetic treatment, the prognosis for this group of patients may be unfavorable. © 2025, Meditsina-Inform LLC. All rights reserved.