Clinical Presentation, Angiographic Characteristics, and In-Hospital Outcomes of Young Adults Undergoing Coronary Angiography in a Resource-Limited Sub-Saharan Setting

Background: Premature coronary artery disease is increasingly observed in low- and middle-income countries; however, data on young adults undergoing invasive coronary evaluation in resource-limited settings remain scarce. This study assessed clinical presentation, angiographic findings, system-related delays, and in-hospital outcomes among young adults undergoing coronary angiography in a Sub-Saharan catheterization center. Methods: We retrospectively analyzed consecutive patients aged ≤ 45 years who underwent coronary angiography, with or without percutaneous coronary intervention, for acute coronary syndromes (ST-elevation myocardial infarction [STEMI], non-ST-elevation myocardial infarction [NSTEMI], or unstable angina) and stable coronary artery disease between June 2021 and June 2025. Demographic data, cardiovascular risk factors, angiographic characteristics, and in-hospital outcomes were collected. The primary outcome was in-hospital mortality. Results: A total of 121 patients were included (median age 41 years; 77.7% male). Acute coronary syndromes predominated, with ST-elevation myocardial infarction in 45.5%. Smoking (55.4%) and khat use (39.7%) were the most prevalent risk factors. System delays were substantial, with a median door-to-balloon time of 355 minutes and 79.3% exceeding 180 minutes. The left anterior descending artery was the most common culprit vessel, and multivessel disease was present in 36.4%. In-hospital mortality was 9.9% and was associated with cardiogenic shock, severely reduced left ventricular ejection fraction, no-reflow/slow-flow phenomena, khat use, and prolonged door-to-balloon time (p < 0.05). Conclusion: Young adults with acute coronary syndromes in resource-limited settings experience substantial early mortality associated with delayed reperfusion, high-risk presentation, and region-specific risk factors. Improving STEMI systems of care and targeting modifiable exposures such as smoking and khat use may help improve outcomes.