A retrospective study was conducted in Oman between May 2006 and June 2007. The main objective of the study was to assess the prevalence, risk factors, presenting features, and in-hospital outcomes of acute coronary syndromes (ACS) patients from Oman aged ≤ 40 years. Furthermore, a comparison was made between ACS patients ≤ 40 and those who were > 40 years of age. In the study, data was analyzed from 1,579 ACS patients across 15 hospitals in Oman enrolled in Gulf RACE (Registry of Acute Coronary Events). Out of the 1,579 patients, 121 (7.6%) were ≤ 40 years of age with a mean age of 36. Male predominance was noted in both age groups. Moreover, the prevalence of smoking, obesity, and family history of CAD was higher among younger patients in comparison to the older patients, but they had lower prevalence of DM, hypertension, and hyperlipidemia. Younger patients were significantly more likely to have ischemic chest pain and categorised as Killip class I. The prevalence of STEMI, non-STEMI, and unstable angina showed no differences among young and older patients. Both groups received aspirin, statins, thrombolytic therapy, and anticoagulants equally; however, younger patients received more clopidogrel, glycoprotein IIb/IIIa inhibitors, β-blockers, and underwent more in-hospital coronary angiograms. Moreover, younger patients experienced less heart failure and significantly less in-hospital mortality. In conclusion, smoking, obesity, and family history of CAD were strong risk factors in the younger age group. They required more vigorous treatment but had better outcomes 5 compared to the older age group. The key to preventing premature ACS lies in weight control and smoking cessation.

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