Among patients presenting with acute myocardial infarction (AMI), the proportion of young individuals has increased in recent years. 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. Young patients with AMI with obstructive coronary artery disease have similar risk factors as older patients except for higher prevalence of smoking, lipid disorders, and family history of premature coronary artery disease, and lower prevalence of diabetes mellitus and hypertension. Smoking cessation is by far the most effective secondary preventive measure. Myocardial infarction with nonobstructive coronary arteries 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.

Spontaneous coronary artery dissection is a frequent pathogenetic mechanism of AMI among young women, requiring a high degree of suspicion, especially in the peripartum period.Aortic dissection extending into the left main coronary artery is rare and carries high mortality, especially when resulting in extensive myocardial infarction. Here we report a case of retrograde extension of type A aortic dissection into the left main coronary artery causing ST-segment elevation myocardial infarction managed by complex percutaneous coronary intervention, which resulted in temporary stabilization of the patient. We briefly review current literature on this approach.

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Mishita
Jornal co-ordinator
Journal of Heart and Cardiovascular Research