(30) Myocardial Infarction in Children: A Review of the English Language Literature from 1980-2023

Background: Little is known about myocardial infarction (MI) in children due to its rare occurrence.

Objectives: We reviewed the English Language literature to describe the clinical characteristics, hospital course, and outcome of children with MI.

Design/Methods: We searched PubMed for case reports and case series published using the keywords ‘myocardial infarction’, ‘children’, and ‘pediatric’. We included only case reports and case series published in the English language. We excluded patients aged >18 years, case reports not published in English, autopsy reports without clinical data, and unavailable full-text manuscripts. Data were extracted onto a Microsoft Excel spreadsheet for additional analysis. The outcomes of interest for the pooled data were clinical characteristics, hospital course and management, and mortality. Descriptive statistics were used to summarize the data.

Results: A total of 159 patients were identified from 141 case reports met the inclusion criteria [median age 10 years; 67.3% male; 17% neonates; 54% adolescents]. More than half of the patients had co-morbid conditions (54.7%). Of these, 18.9% had Kawasaki disease, 13.8% had congenital cardiac defects, and 3.1% had nephrotic syndrome/hyperlipidemia. The presenting symptoms included chest pain (52.2%) and dyspnea (34.5%). Troponins and creatine kinase were elevated in 62.2% and 40%, respectively. The most frequent EKG finding was S-T segment elevation (46%), followed by S-T depression in 13.8%. Heart failure/hypotension/cardiogenic shock was present in 33.3%, and 25.2% received vasopressor support. Echocardiographic findings included median ejection fraction of 35% and akinesia/hypokinesia of the affected ventricular in 47%. Cardiac catheterization was performed in 75% and it demonstrated the thrombosis or occlusion of at least one coronary artery in 44.2%, stenosis of at least one coronary artery in 14.2%, coronary artery aneurysm only in 9.2%, and normal coronary arteries in 18.3%. The management of MI varied, with medical therapy only offered in 52.8%. The rest received medical therapy plus balloon angioplasty or stenting (12.6%), thrombectomy (7.5%), coronary artery bypass graft (5%), and ECMO (2.5%). The median length of stay was 14 days and 17.6% died.

Conclusion: Myocardial infarction is rare in children but carries a high mortality rate. The wide variation in management emphasizes the need for further studies and evidenced-based guidelines to guide management and improve outcomes in children with MI.