Overview
- A Mayo Clinic review of 4,116 troponin-positive events in 2,780 patients (2003–2018) found that 53% of myocardial infarctions in women aged 65 or younger were nonatherosclerotic, compared with 25% in men.
- In women, causes were distributed as atherothrombosis 47%, supply–demand mismatch 34%, spontaneous coronary artery dissection 11%, vasospasm 3%, embolism 2%, and MINOCA-U 3%, while men had 75% atherothrombotic events.
- Spontaneous coronary artery dissection was initially misclassified in 55% of cases, with diagnostic accuracy improving after 2012 as angiographic recognition evolved.
- Five-year mortality differed sharply by cause, reaching about 33% for supply–demand mismatch, roughly 8% for atherothrombosis or embolism, and no cardiovascular deaths reported after SCAD.
- Researchers urge greater awareness and targeted imaging for nontraditional causes, note lower overall incidence of MI in women than men, and report that truly unexplained cases were under 3% in a predominantly White cohort.