Clinical characteristics, management, and in-hospital outcomes of premature acute coronary syndrome at a tertiary cardiac center in Kurdistan, Iraq: a retrospective observational study

Abstract Background Premature acute coronary syndrome (ACS) causes substantial cardiovascular morbidity in younger adults, but data from Iraq and the Kurdistan Region remain limited. We describe the clinical characteristics, management, and in-hospital outcomes of premature ACS at a tertiary cardiac center in Sulaymaniyah. Methods We conducted a retrospective observational study of consecutive patients admitted with premature ACS to Sulaimani Cardiac Hospital from January 1 to April 30, 2026. Premature ACS was defined as ACS in men aged ≤ 55 years and women aged ≤ 65 years. Demographic, risk-factor, presentation, investigation, treatment, and in-hospital outcome data were extracted from hospital records. Exploratory subgroup comparisons and a clinically specified multivariable logistic regression were performed. Results Among 1051 ACS admissions, 310 patients (29.5%) met the premature-ACS criteria. The mean age was 51.3 ± 7.1 years and 199 (64.2%) were male. Among patients with documented status, hypertension was present in 144/308 (46.8%), diabetes mellitus in 116/309 (37.5%), current smoking in 119/250 (47.6%; 38.4% of the full cohort), and dyslipidemia in 95/242 (39.3%; 30.6% of the full cohort). Chest pain was the predominant presentation (86.8%). NSTEMI accounted for 49.0%, STEMI 44.8%, and unstable angina 6.1%. PCI was attempted in 236 patients (76.1%) and successfully completed in 234; among successful PCI, stent implantation was documented in 208, 3 were recorded without stent implantation, and stent status was unavailable in 23. A composite adverse in-hospital outcome occurred in 62 patients (20.0%; 95% CI 15.9–24.8), including acute heart failure or pulmonary edema in 40 (12.9%), cardiogenic shock in 15 (4.8%), and in-hospital death in 4 (1.3%; 95% CI 0.5–3.3). Women were older, as expected from the sex-specific age thresholds, and had higher unadjusted rates of the composite outcome. In exploratory multivariable analysis, older age and STEMI were associated with the composite outcome, whereas sex, hypertension, diabetes mellitus, and prior coronary disease were not. Conclusions Premature ACS represented nearly one-third of ACS admissions at this tertiary center and was characterized by a high burden of traditional cardiovascular risk factors. Despite low in-hospital mortality, adverse outcomes were common, supporting earlier prevention, symptom recognition, and risk-factor control in younger adults in the region.