Distinct Risk Profiles, Management Patterns, and In-Hospital Outcomes of Young Adults with Acute Coronary Syndrome in Yemen: A Cross-Sectional Analysis

Abstract

Objectives: This study aimed to compare the clinical characteristics, risk factors, management strategies, and in-hospital outcomes of young acute coronary syndrome (ACS) patients (≤45 years) with those of older adults, addressing a significant evidence gap in the region. Methodology: This cross-sectional study included all consecutive patients presenting with ACS. Data were collected on demographics, cardiovascular risk factors, clinical presentation, angiographic findings, treatment modalities, and in-hospital outcomes. Comparative analyses between age groups were performed, and multivariable logistic regression identified predictors of in-hospital mortality. Results: Among 310 ACS patients, 23.2% were ≤45 years. Young adults demonstrated a distinctive risk profile characterized by significantly higher prevalence of khat chewing, smoking, and family history of premature coronary artery disease, whereas diabetes mellitus was more common among older adults (p < 0.05). Younger patients more frequently underwent coronary angiography and PCI, while older patients were managed more conservatively (p < 0.05). Single-vessel disease was predominant in younger individuals, contrasting with greater multivessel involvement in older patients. Although overall complication and mortality rates were comparable between groups, older adults exhibited higher GRACE scores and more frequent heart failure. Independent predictors of in-hospital mortality—including low systolic blood pressure, elevated serum creatinine, reduced LVEF, multivessel disease, and delayed symptom-to-door time—were consistent across age groups. PCI was independently protective. Conclusion: Young Yemeni adults with ACS exhibit unique behavioral and familial risk patterns but share similar mortality risk predictors with older patients. These findings highlight an urgent need for targeted prevention strategies addressing modifiable behaviors—especially smoking and khat chewing.