Abstract
Background: CAD is a widespread cause of death worldwide and is no longer restricted to the elderly. There have been increasing numbers of young individuals in the developing world including the Middle East presenting with ACS. CAD occurs most commonly at the age of productive life, which has severe physical, psychological and social consequences. Smoking and dyslipidemia are the leading, potentially modifiable factors in young people; however, genetic predisposition and drug use also play a role in some cases. 'This P/L may have distinct angiographic patterns, which need specific diagnosis and treatment. Objective: This article explored clinical characteristics, angiographic types and risk factors of young ACS patients. Methods: A retrospective observational study was conducted at Shaheed Al-Mihrab Cardiac Center in Babylon, Iraq. Ninety-two patients aged below 40 years who presented with ACS between September 2022 and September 2023 and underwent coronary angiography were included. Demographic, clinical, and angiographic data were analyzed using SPSS version 29, with results expressed as means, frequencies, and percentages. Results: Most patients were male (92%). Smoking was the most frequent modifiable risk factor (36.3%), followed by dyslipidemia (24.2%). Anterior wall myocardial infarction was the commonest presentation (84.9%). Obstructive coronary artery disease was found in 68.2% of patients, predominantly involving the left anterior descending artery, while the remaining patients had non-obstructive disease, suggesting alternative mechanisms such as vasospasm or plaque erosion. Conclusion: ACS in young adults is strongly linked to preventable risk factors, particularly smoking and lipid abnormalities, and is commonly associated with significant LAD involvement. These findings highlight the urgent need for focused prevention strategies in this vulnerable population.

Key words: Acute myocardial infarction, coronary artery disease, young adults, modifiable risk factors, smoking, dyslipidemia, left anterior descending artery.