{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:54:42Z","timestamp":1790610882148,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Acute myocardial infarction (AMI) remains a leading cause of death worldwide and sometimes occurs as the inaugural presentation of CAD. Studies have been heterogeneous in reporting what proportion this population represents; therefore, we sought to review the evidence of myocardial infarction as the initial manifestation of CAD. Methods: We conducted a scoping review of 25 studies (1979\u20132021) assessing the prevalence, risk factors, and outcomes of patients who experience AMI as the first clinical manifestation of CAD. Results: Across studies, most found that half of AMI patients present with no prior angina or CAD diagnosis. These patients tend to be younger and have fewer traditional risk factors. Sex differences were inconsistently reported, though some studies suggest that women may be more likely to present with unheralded AMI. Diabetes and hypertension were interestingly more common in patients with known CAD. Patients with unheralded AMI demonstrate a larger infarct size and may have a higher likelihood of adverse cardiovascular events compared to those with known CAD. Conclusions: Our findings highlight a critical gap in the current risk models of CAD evaluation, which are often symptom-based and focused on detecting ischemia, thus failing to detect a significant proportion that present with AMI as their initial manifestation of CAD.<\/jats:p>","DOI":"10.3390\/jcm15072603","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:22:36Z","timestamp":1774858956000},"page":"2603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Myocardial Infarction as the First Clinical Manifestation of Coronary Artery Disease: A Scoping Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Maya","family":"D\u2019Angelo","sequence":"first","affiliation":[{"name":"Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeliki","family":"Psycharis","sequence":"additional","affiliation":[{"name":"Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolo","family":"Piazza","sequence":"additional","affiliation":[{"name":"Centre for Outcomes Research and Evaluation, The Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada"},{"name":"Division of Cardiology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"De Luca","sequence":"additional","affiliation":[{"name":"Service of Cardiology, AOU \u201cPoliclinico G. Martino\u201d, University of Messina, 98121 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvin","family":"Kedhi","sequence":"additional","affiliation":[{"name":"Centre for Outcomes Research and Evaluation, The Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada"},{"name":"Division of Cardiology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ehy563-P4617","DOI":"10.1093\/eurheartj\/ehy563.P4617","article-title":"P4617 Acute myocardial infarction as a first time presentation of coronary artery disease in Poland in 2014\u20132016","volume":"39","author":"Siudak","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"843","DOI":"10.4244\/EIJ-D-17-00078","article-title":"Reduced periprocedural mortality and bleeding rates of radial approach in ST-segment elevation myocardial infarction. Propensity score analysis of data from the ORPKI Polish National Registry","volume":"13","author":"Siudak","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1056\/NEJMra1606915","article-title":"Acute myocardial infarction","volume":"376","author":"Anderson","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2991\/jegh.k.201217.001","article-title":"Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review","volume":"11","author":"Ralapanawa","year":"2021","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_5","unstructured":"World Health Organization (2025, May 21). Global Health Estimates: Life Expectancy and Leading Causes of Death and Disability. Available online: https:\/\/www.who.int\/data\/gho\/data\/themes\/mortality-and-global-health-estimates."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1001\/jama.2021.1527","article-title":"Diagnosis and management of stable angina: A review","volume":"325","author":"Joshi","year":"2021","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/j.jacc.2017.02.001","article-title":"ACC\/AATS\/AHA\/ASE\/ASNC\/SCAI\/SCCT\/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients with Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons","volume":"69","author":"Patel","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"256","DOI":"10.21037\/atm.2016.06.33","article-title":"Epidemiology of coronary heart disease and acute coronary syndrome","volume":"4","author":"Leischik","year":"2016","journal-title":"Ann. Transl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.jcmg.2022.03.010","article-title":"Coronary Atherosclerosis in an Asymptomatic U.S. Population","volume":"15","author":"Nasir","year":"2022","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.ahj.2007.02.027","article-title":"Prediction of first coronary events with the Framingham score: A systematic review","volume":"153","author":"Eichler","year":"2007","journal-title":"Am. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1016\/0002-8703(92)90798-Z","article-title":"The prognostic significance of angina pectoris preceding the occurrence of a first acute myocardial infarction in 4166 consecutive hospitalized patients","volume":"123","author":"Behar","year":"1992","journal-title":"Am. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1590\/S0066-782X2002000400006","article-title":"Acute myocardial infarction: The first manifestation of ischemic heart disease and relation to risk factors","volume":"78","author":"Manfroi","year":"2002","journal-title":"Arq. Bras. De Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/0002-8703(84)90460-5","article-title":"Effects of the presence or absence of preceding angina pectoris on left ventricular function after acute myocardial infarction","volume":"108","author":"Matsuda","year":"1984","journal-title":"Am. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1161\/01.CIR.87.6.1938","article-title":"Comparison of coronary angiographic findings in acute and chronic first presentation of ischemic heart disease","volume":"87","author":"Bogaty","year":"1993","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1136\/hrt.57.2.139","article-title":"Importance of angina for development of collateral circulation","volume":"57","author":"Fujita","year":"1987","journal-title":"Br. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/0002-8703(79)90353-3","article-title":"The incidence and pattern of angina prior to acute myocardial infarction: A study of 577 cases","volume":"97","author":"Harper","year":"1979","journal-title":"Am. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1161\/01.CIR.91.1.37","article-title":"Previous angina alters in-hospital outcome in TIMI 4. A clinical correlate to preconditioning?","volume":"91","author":"Kloner","year":"1995","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0002-9149(97)00884-9","article-title":"Previous angina reduces in-hospital death in patients with acute myocardial infarction","volume":"81","author":"Kobayashi","year":"1998","journal-title":"Am. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S0002-9149(97)00317-2","article-title":"Prognostic Significance of Angina Pectoris \u2265 30 Days Before Acute Myocardial Infarction in Patients \u2265 75 Years of Age","volume":"80","author":"Jacquemin","year":"1997","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/0735-1097(95)80002-X","article-title":"Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction","volume":"26","author":"Anzai","year":"1995","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1016\/j.jacc.2003.09.069","article-title":"Angina pectoris prior to myocardial infarction protects against subsequent left ventricular remodeling","volume":"43","author":"Solomon","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/0002-9149(88)90111-7","article-title":"Prognostic significance of angina pectoris before first acute myocardial infarction","volume":"61","author":"Pierard","year":"1988","journal-title":"Am. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1378\/chest.81.6.681","article-title":"Angina pectoris before and after myocardial infarction. Angiographic correlations","volume":"81","author":"Midwall","year":"1982","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1093\/eurheartj\/14.4.484","article-title":"Occurrence of angina pectoris prior to acute myocardial infarction and its relation to prognosis","volume":"14","author":"Herlitz","year":"1993","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1161\/01.CIR.67.4.743","article-title":"Coronary anatomy and prognosis after myocardial infarction in patients 60 years of age and younger","volume":"67","author":"Roubin","year":"1983","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/0735-1097(92)90134-9","article-title":"Antecedent angina pectoris predicts worse outcome after myocardial infarction in patients receiving thrombolytic therapy: Experience gleaned from the International Tissue Plasminogen Activator\/Streptokinase Mortality Trial","volume":"20","author":"Barbash","year":"1992","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"136","DOI":"10.4068\/cmj.2020.56.2.136","article-title":"Impact of Previous Angina on Clinical Outcomes in ST-Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention","volume":"56","author":"Han","year":"2020","journal-title":"Chonnam Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1161\/01.CIR.97.11.1042","article-title":"Prospective temporal analysis of the onset of preinfarction angina versus outcome: An ancillary study in TIMI-9B","volume":"97","author":"Kloner","year":"1998","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1157\/13124633","article-title":"Influence of chronic angina prior to infarction in the diagnosis of viability and left ventricular remodelling in myocardial perfusion gated-SPECT","volume":"27","year":"2008","journal-title":"Rev. Espa\u00f1ola Med. Nucl."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.ijcard.2015.03.328","article-title":"Time-dependent effect of preinfarction angina pectoris and intermittent claudication on mortality following myocardial infarction: A Danish nationwide cohort study","volume":"187","author":"Schmidt","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"ehy563-P3428","DOI":"10.1093\/eurheartj\/ehy563.P3428","article-title":"P3428Changing profile and outcome of AMI patients with previously known coronary artery disease. The FAST-MI programme","volume":"39","author":"Danchin","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1161\/CIRCULATIONAHA.117.030798","article-title":"Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015","volume":"136","author":"Puymirat","year":"2017","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1093\/eurheartj\/ehu286","article-title":"Association between clinical presentations before myocardial infarction and coronary mortality: A prospective population-based study using linked electronic records","volume":"35","author":"Herrett","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_34","first-page":"235","article-title":"Type and timing of heralding in ST-elevation and non-ST-elevation myocardial infarction: An analysis of prospectively collected electronic healthcare records linked to the national registry of acute coronary syndromes","volume":"2","author":"Herrett","year":"2013","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/0002-8703(93)90182-9","article-title":"Preexisting cardiovascular conditions and long-term prognosis after initial myocardial infarction: The Framingham Study","volume":"125","author":"Cupples","year":"1993","journal-title":"Am. Heart J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s40256-025-00739-8","article-title":"One-Year Prognostic Differences and Management Strategies between ST-Elevation and Non-ST-Elevation Myocardial Infarction: Insights from the PRAISE Registry","volume":"25","author":"Spadafora","year":"2025","journal-title":"Am. J. Cardiovasc. Drugs"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"10","DOI":"10.15420\/ecr.2016:32:1","article-title":"Cardiovascular disease in women: Understanding symptoms and risk factors","volume":"12","author":"Sharma","year":"2017","journal-title":"Eur. Cardiol. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.ijcard.2019.02.005","article-title":"Women-specific predictors of cardiovascular disease risk\u2014New paradigms","volume":"286","author":"Maffei","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"80","DOI":"10.4239\/wjd.v6.i1.80","article-title":"Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment","volume":"6","year":"2015","journal-title":"World J. Diabetes"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1056\/NEJMra2405153","article-title":"The Inherited Basis of Coronary Artery Disease","volume":"394","author":"Schunkert","year":"2026","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e016443","DOI":"10.1161\/CIRCIMAGING.123.016443","article-title":"Coronary Atherosclerotic Plaque Burden Assessment by Computed Tomography and Its Clinical Implications","volume":"17","author":"Vatsa","year":"2024","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4671","DOI":"10.1093\/eurheartj\/ehab433","article-title":"Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: The COMBINE OCT\u2013FFR trial","volume":"42","author":"Kedhi","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e014667","DOI":"10.1161\/CIRCINTERVENTIONS.124.014667","article-title":"FFR-Negative Nonculprit High-Risk Plaques and Clinical Outcomes in High-Risk Populations: An Individual Patient-Data Pooled Analysis from COMBINE (OCT-FFR) and PECTUS-obs","volume":"18","author":"Volleberg","year":"2025","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"B80","DOI":"10.1093\/eurheartj\/suz032","article-title":"The CLIMA study: Assessing the risk of myocardial infarction with a new anatomical score","volume":"21","author":"Romagnoli","year":"2019","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1056\/NEJMoa1803538","article-title":"Five-Year Outcomes with PCI Guided by Fractional Flow Reserve","volume":"379","author":"Xaplanteris","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1016\/S0140-6736(25)00055-8","article-title":"The Lancet Commission on rethinking coronary artery disease: Moving from ischaemia to atheroma","volume":"405","author":"Zaman","year":"2025","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.jcct.2025.09.014","article-title":"Incremental value of a CCTA-derived AI-based ischemia algorithm over standard CCTA interpretation of predicting myocardial ischemia in patients with suspected coronary artery disease","volume":"19","author":"Nabeta","year":"2025","journal-title":"J. Cardiovasc. Comput. Tomogr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:45:27Z","timestamp":1774860327000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,29]]},"references-count":47,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072603"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072603","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,29]]}}}