Gender-based Differences in Young Indian Patients with Acute Coronary Syndrome: A Comprehensive Analysis

Objectives: The steep rise in acute coronary syndrome (ACS) cases among young adults, particularly those ≤ 45 years old, poses a significant concern, especially in India. This study delved into the baseline characteristics, risk factors, and echocardiographic and angiographic profiles of ACS patients under 45 years of age, with a focus on discerning gender-based differences. Materials and Methods: A retrospective, observational cohort study was conducted, including young adults aged 18–≤45 years diagnosed with ACS who underwent coronary angiography. Demographic, clinical, and angiographic data were meticulously analyzed. Results: Our study of 550 young ACS patients (mean age: 40.2 ± 4.7 years) from January 2018 to July 2023 found that females, forming nearly 10% of the cohort, had a higher obesity prevalence (38.7% vs. 56.9%, P = 0.012). Multivessel disease was less common in females (P < 0.0001). Left anterior descending (67.3%) and right coronary (41.3%) arteries predominantly affected, seen in significantly higher proportion of males (P = 0.003 and P = 0.011, respectively). Left ventricular ejection fraction ≤40% was notably lower in males (P = 0.029). Percutaneous coronary intervention (PCI) was the primary treatment modality (59.3%), with significantly lower rates among females (43.1% vs. 60.9%, P = 0.040). Conclusion: Despite the increasing prevalence, research on gender differences in young adults with ACS is limited, especially in the Indian population. We observed higher obesity rates in females compared to males, along with lower rates of multivessel disease in females. Males had lower ejection fractions and underwent PCI more often than females. These findings highlight the need for gender-specific approaches and tailored interventions in ACS management.