Our study provides the largest and most recent analysis for the incidence, characteristics, and outcomes of teenagers with acute myocardial infarction. The rate of AMI cases per 100,000 hospitalization records in general has been rising. This further highlights various potential problems among teenagers, which can be linked with the rise in various substance abuse [6]. As a matter of fact, our study found that teenagers with AMI were more likely to be those who smoke, or use cannabis or cocaine. Cannabis is known to alter blood flow to the heart and activate the sympathetic system. This provokes a higher demand of blood, which cannot be fully met [7]. Meanwhile, cocaine can trigger coronary artery vasospasm that reduces blood flow to the heart. It can also upregulate the sympathetic system, leading to a rise in heart rate and contractility, and thus to a rise in oxygen demand [7, 8]. Smoking plays an important role in atherogenesis, and various studies have reported events of AMI in young adults even with normal coronary arteries [9]. Our study thus confirms the findings previously reported by several small sample studies on the event and the impact of these substances among teenagers and young adults. However, further studies can help evaluate the causative and associative roles of these risk factors in these patients [10, 11].

Furthermore, a male predominance was noted, and an increased risk was seen among males compared to females. Male adolescents and teenagers are more likely to be exposed to various risk factors. In a recent study, 16.5% of male adolescents reported to be smokers, compared to only 1.9% of females [12]. Similar findings have also been reported among cannabis users; 26.6% of males (vs. 9.8% of females) between the ages of 13 and 17 years were frequent users [13]. In addition, our study highlighted the impact of weekend admission, which is often believed to include more severe patients [14, 15]. Finally, another risk factor was the presence of hypertension. The role of hypertension has been highly elaborated in the literature because it can trigger damage and various vascular insults that form part of the pathophysiology of AMI. A recent analysis from Hardy et al. also noted that the blood pressure levels among children and adolescents in the United States increased between 2015 and 2018 [16].

Several racial and socioeconomic differences were also reported in our analysis. While a higher percentage of AMI cases were classified as White, the odds of the event was higher among Black teenagers. The higher percentage reflects the higher census-based distribution of American teenagers, with a higher percentage being racially White. Our findings on racial disparities differ from a past study on adolescents that used the 1998–2001 NIS that failed to find any racial disparities at that time [2]. The higher odds of AMI among Black teenagers should also be further investigated. While the disparities may be linked with any racial predisposition (if any) or risk factor linked with the pathophysiology of AMI, social causes such as awareness and access to various external risk factors should also be studied. This can help us understand the differences seen between the 2 studies that are now 2 decades apart, and a better understanding can help alleviate such impact and lower the incidence of AMI among them [17, 18]. Further studies may help better understand the causes, and effective ways to tackle these differences can be implemented.

Our analysis failed to find differences in the odds of AMI among teenagers based on median household incomes and on various factors such as diabetes. The impact of diabetes is insidious and thus was not statistically significant in younger patients. Due to the lack of adequate data from different countries and facilities, we are unable to compare the incidence rate of AMI among teenagers, the mortality rates, and the rates of teenagers with AMI requiring CABG or PCI. Moreover, because the database does not allow users to ascertain several factors such as medications being used, levels of troponin, and other laboratory findings, future studies in a clinical setting are encouraged to further investigate the results of our study. Moreover, the database uses a coding system, which can be prone to errors due to misclassification or coding by phisicians. Over the years, HCUP has adopted several measures to limit the impact of such shortcomings and make the database more accurate.

In conclusion, our study found that a teenager is more likely to be hospitalized for AMI if that person is admitted on a weekend, is a smoker, uses cannabis or cocaine, has hypertension, is covered by forms of insurance other than Medicaid or private, or is racially Black, while lower odds were seen in females compared to males.