Key result
Age 40 or younger with ACS is linked to lower 12-month MACE versus older patients.
Why the study?
ACS in young adults exhibits distinct characteristics compared with older populations, but detailed comparative data in Chinese cohorts remain limited.
Do clinical profiles, revascularization strategies, and 12-month MACE differ between young (≤40 years) and older (>40 years) adults presenting with acute coronary syndrome?
Cohort (n=224)
No
Do clinical profiles, revascularization strategies, and 12-month MACE differ between young (≤40 years) and older (>40 years) adults presenting with acute coronary syndrome?
p-value: p=<0.038
Supports age-specific risk stratification and revascularization in ACS; extends evidence of distinct clinical profiles and treatment patterns in young patients.
Acute coronary syndrome (ACS) in young adults (≤ 40 years) exhibits distinct characteristics compared with older populations, yet detailed comparative data in Chinese cohorts remain limited. This comparative retrospective cohort study analyzed 112 consecutive ACS patients aged ≤ 40 years (Young Group) and 112 matched non-young ACS patients (age > 40 years, Non-Young Group) undergoing coronary angiography at a tertiary center between September 2018 and November 2024. We evaluated clinical profiles, angiographic features, revascularization strategies, and 12-month major adverse cardiac events (MACE). Compared with the Non-Young Group, young patients exhibited a higher male predominance (p < 0.001) and a lifestyle related risk profile characterized by significantly higher rates of current smoking (p < 0.001) and obesity (p < 0.001). Young patients more frequently presented with STEMI (p = 0.009) and single vessel disease (p = 0.011), with thrombotic lesions being the dominant etiology (p = 0.005). Regarding treatment, the Young Group had a significantly higher utilization of drug coated balloons (p < 0.001) and lower stent implantation rates (p < 0.001). At 12 months, the MACE rate was significantly lower in the Young Group (p = 0.038). Within the young cohort, multivessel disease (aHR 2.89), LVEF < 50% (aHR 3.25), and stent non-implantation (aHR 2.30) were independent MACE predictors. Clustering of ≥ 2 key modifiable risk factors (dyslipidemia, obesity, smoking) conferred a 3 to 5 fold higher MACE risk in young adults (p < 0.001). Young ACS patients possess a distinct clinical and angiographic profile characterized by a higher thrombotic burden and lifestyle related risk factors compared with older patients. While they exhibit more favorable short term survival and respond well to stent-less revascularization strategies, their long term prognosis is heavily dependent on the aggressive modification of synergistic modifiable risk factors.
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Wang et al. (2026) conducted a cohort in Acute coronary syndrome (ACS) (n=224). Young age (≤40 years) vs. Older age (>40 years) was evaluated on Major adverse cardiac events (MACE) at 12 months (p=<0.038). Young adults (≤40 years) with acute coronary syndrome experienced a significantly lower rate of major adverse cardiac events at 12 months compared to older patients.
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