Demographic, clinical, and angiographic characteristics of patients with premature coronary artery disease: Insights from a multicenter registry

Coronary artery disease (CAD) is the leading cause of mortality worldwide and increasingly affects younger individuals, posing a significant burden on public health systems. This study aims to evaluate the clinical, biochemical, and angiographic characteristics of premature myocardial infarction (PMI) in Egyptian patients aged ≤ 40 years and identify key associated risk factors. A multicenter, cross-sectional study enrolled 156 PMI patients and 247 age- and sex-matched healthy controls between January 2022 and December 2023. Clinical profiles, risk factors, anthropometric measures, laboratory markers, and coronary angiographic findings were assessed. Logistic regression analysis identified independent predictors of PMI. Compared to controls, PMI patients had significantly higher body mass index (27.5 ± 4 vs. 25.0 ± 2.1 kg/m 2 , P < 0.001), prevalence of high-fat diet (67.9% vs. 29.6%), smoking (62.8% vs. 48.2%), diabetes (49.4% vs. 10.1%), dyslipidemia (59% vs. 10.5%), and obesity (35.9% vs. 8.5%), all P < 0.001. High-density lipoprotein ≤45 mg/dL (odds ratio [OR] = 13.37), dyslipidemia (OR = 12.22), triglycerides ≥130 mg/dL (OR = 7.03), diabetes (OR = 8.66), and obesity (OR = 6.03) were the strongest predictors of PMI. Angiographic findings revealed single-vessel disease in 41%, left main involvement in 20.5%, and nonatherosclerotic CAD in 9%. Inhospital mortality was 3.2%, and heart failure occurred in 30.8%. Premature CAD is no longer rare in young Egyptians. Early identification and aggressive management of modifiable risk factors – especially dyslipidemia, smoking, and obesity – are vital to reduce the clinical burden and improve prognosis in this vulnerable group.