Clinical Profile and Gender Variances among Premature Coronary Artery Disease Cases Undergoing Percutaneous Coronary Intervention: A Retrospective Analysis

Abstract Background: Cardiovascular disease (CVD) ranks as the leading cause of death in India and globally, with ischemic heart disease as the predominant factor. In India, the prevalence of CVD in young adults has increased due to lifestyle and environmental risk factors despite reduced overall acute coronary syndrome (ACS) hospitalizations globally. South Asians, especially in India, demonstrate a high mortality rate from coronary artery disease (CAD) with frequent occurrences of ACS at an early age. This study aimed to evaluate the clinical and angiographic characteristics of patients under 35 with premature CAD (PCAD) undergoing percutaneous coronary intervention at a center in southern India, with a focus on gender-based risk differences. Methods: Single center retrospective observational study with 405 premature CAD cases (age <35 years), who underwent PCI from April 2017 to July 2022. Data about co-morbidities, risk factor and coronary angiography were obtained from hospital records. Gender variance was analysed. Results: Of the 405 patients, 90.5% were male, with an average age of 31.45 years. Smoking was prevalent among 55.3% of cases. Females had higher rates of diabetes (34.2%) and hypertension (25.7%) compared with males (7.8% and 6.7%, respectively; P < 0.001 for both). ACS presented in 97% of cases, predominantly as anterior wall myocardial infarction. Coronary angiography revealed single-vessel disease in 82.2% of patients, most commonly left anterior descending artery (64.8%), and most cases had preserved ejection fraction (41.2% cases). Dyslipidemia was common, with high LDL and triglycerides and low high-density lipoprotein levels. Notably, gender differences were observed in risk factors and comorbidities but not in presentation or angiographic characteristics. Conclusion: PCAD remains a major health concern in young Indian adults. Gender differences in presentation and comorbidities were observed. Women with CAD displayed more comorbidities, whereas men were more likely to be smokers. This calls for aggressive preventive strategies in young, particularly women.