Rising incidence of STEMI in younger adults: time to redefine premature CAD or a new high-risk group emerging?

Abstract Background The rising incidence of acute STEMI in younger males (55 years) and females (65 years) challenges the current definition of premature coronary artery disease (CAD). This trend raises concerns about overlooked risk factors, changing lifestyles, and potential genetic influences. Purpose To analyze the rising incidence of STEMI in younger adults and determine whether this group represents a new high-risk population or if the definition of premature CAD needs to be redefined for better prevention and management. Methods A cross-sectional study was conducted at a tertiary care cardiology center over one year. Patients were enrolled using non-probability consecutive sampling after approval from institutional ethical review board and informed consent. Baseline characteristics and risk factors were recorded. Primary PCI was performed as per hospital protocol, and angiographic findings were documented. Males were categorized into four age groups: 35, 35–45, 45–55, and 55 years, while females were grouped as 45, 45–55, 55–65, and 65 years. Data were analyzed using SPSS version 26.0, with categorical variables presented as frequencies and percentages. Chi-square tests were applied to assess associations between age groups and angiographic findings, with a significance level set at p0.05. Results A total of 5,286 STEMI patients were analyzed, with a mean age of 52.53 ± 10.90 years. Males constituted the majority (4,143/5286; 78.4%). Among males, Group 1 (35 years) had the highest proportion of cases (1,638/4,143; 39.5%), whereas in females, Group 2 (45–55 years) was most affected (402/1,143; 35.2%). Diabetes prevalence was significantly higher in females (47.5%) compared to males (29.2%) (p 0.001), peaking in Group 2 females (54.5%) and Group 4 males (55 years) (32.8%). Hypertension was more common in females (60.3%) than males (29.4%) (p 0.001), with the highest rates in Group 2 females (64.7%) and Group 4 males (33.1%). Smoking was significantly higher in males (48.4%) than females (14.8%) (p = 0.006), while obesity was prevalent in both genders (males: 51.8%, females: 50.5%) (p = 0.001). Angiographic analysis showed that single-vessel CAD was predominant in Group 2 males (69.4%) and Group 2 females (50.5%), whereas three-vessel CAD was most frequent in Group 1 males (21.6%) and Group 4 females (28.4%) (p 0.001). Conclusion The rising incidence of STEMI in younger males (55 years) and females (65 years) signals an urgent need to reassess the definition of premature CAD. Our findings highlight a stark gender disparity in risk factor profiles. The predominance of single-vessel disease in younger patients suggests early yet aggressive atherosclerotic involvement, whereas multi-vessel CAD in older females underscores the cumulative impact of lifelong cardiovascular risk exposure. Is this an evolving epidemic of young-onset CAD or a previously overlooked population with high-risk atherosclerosis?Age-wise distribution of CAD in males Age-wise distribution of CAD in females