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June 25, 2025, 01:34

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We read with great interest the work of Abdelsamie and colleagues, who describe the characteristics of acute myocardial infarction (AMI) in young patients, including presentation, risk factors, coronary angiography findings, and management strategies.1 While AMI is predominantly observed in individuals over 45, its occurrence in younger adults has garnered increasing attention due to its distinct risk factors and long-term consequences. When it occurs, early-onset AMI is often associated with substantial morbidity, psychosocial impact, and economic burden for patients and their families.2 We commend the authors for addressing this important topic, we would like to offer several suggestions that may help to further strengthen the clarity and clinical applicability of the study. First, the Methods section of the manuscript appears concise and would benefit from additional details to enhance reproducibility. Specifically, the Subjects subsection could provide a more comprehensive account of the exclusion criteria. While inclusion criteria are described, it remains unclear whether important conditions, such as severe cardiomyopathy, rheumatic heart disease, or malignancy, were excluded. Clarifying these aspects would strengthen the credibility and interpretability of the study findings. Additionally, more structured descriptions of Clinical data collection are warranted. It would be helpful to specify how many categories of clinical data were collected (e.g., demographic, biochemical, echocardiographic, electrocardiographic), which variables were included in each, and at what time points they were assessed (e.g., at admission, post-intervention, at discharge). Second, while the authors correctly note that single-vessel disease predominates among young AMI patients and present the distribution of culprit vessels, the severity and characteristics of the lesions remain insufficiently detailed. Specifically, the lack of ACC/AHA lesion classification and TIMI flow grading limits the angiographic assessment. These indices are clinically relevant for guiding intervention strategy and risk stratification and would add valuable context to the findings. Third, although the study aims to explore the presentation, risk factors, angiographic findings, and management of young AMI patients, it is noteworthy that clinical symptoms at presentation are not detailed. Given the clinical importance of symptom characterization for early recognition and diagnosis, including this information would help clinicians recognize such cases more effectively. Regarding the management domain, further elaboration on pharmacological therapy, particularly the use of beta-blockers, statins, and antiplatelet agents, would enhance the clinical relevance of the study. It also raises the question of whether young AMI patients tend to present with higher heart rates, and if so, whether adequate heart rate control was achieved during hospitalization or at discharge. As heart rate plays a crucial role in the progression and prognosis of coronary artery disease, such information would provide valuable insight into the effectiveness of secondary prevention strategies in this specific population. Finally, we appreciate the authors’ observation that obesity, hyperlipidemia, and smoking are prominent in young AMI patients. However, to strengthen this conclusion, we encourage the authors to consider a prospective cohort study design with multivariable adjustment, which could formally assess whether these are independent risk factors for early-onset AMI. Such analysis would increase the translational value of their findings and potentially guide targeted prevention strategies in this unique population. In conclusion, this study brings attention to a clinically important and under-explored population. We hope that the authors will consider these suggestions to further refine their methodological and clinical insights in future work. References 1. Ahmed Hegazi Abdelsamie HOA, Ahmed Taha Abdelwahed. Acute myocardial infarction in the young: A 3-year retrospective study. World Journal of Cardiology 2025;17(6) doi: 10.4330/wjc.v17.i6.106445 2. Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol 2016;8(12):728-34. doi: 10.4330/wjc.v8.i12.728

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