Suspected myocardial infarction in paediatrics: a retrospective review

Acute myocardial infarction is rare in paediatric patients, with limited published data on incidence, diagnosis, management strategies, and outcomes. A systematic retrospective review was conducted on patients aged 1 day to 21 years who presented with concerns for ST-elevation myocardial infarction at a paediatric institution and an affiliated adult hospital (1/2013-12/2023). Out of 965 screened patients, 13 met the inclusion criteria. The cohort had a mean age of 15 years (standard deviation ± 4 years), with the youngest patient being 11 months old. The study population consisted of 12 males (92%) and 1 female (8%), with ethnic distribution as follows: Caucasian (69%), African American (15%), and Hispanic (15%). An electrocardiogram with ST-segment changes was observed in all patients. Echocardiography revealed a normal ejection fraction in 54% of patients. Most patients (54%) had CHD, with three patients (23%) being undiagnosed at the time of the initial presentation. Seven patients (54%) underwent cardiac catheterization at the adult hospital, while 2 patients (15%) had coronary evaluation at the paediatric facility. One percutaneous catheter intervention was performed in a patient with known coronary stenosis at the paediatric facility. Three patients (23%), all with congenital heart disease, had cardiac arrest during cardiac catheterisation, resulting in extracorporeal membrane oxygenation cannulation. These findings suggest evaluation of pediatric patients presenting with ST-segment elevation can be performed at a pediatric center to rule out congenital heart disease, especially prior to referral to an adult facility for coronary intervention.