Abstract Body (Do not enter title and authors here): Background
Premature coronary artery disease (CAD) is an important cause of morbidity and mortality amongst the younger patient population and presents unique clinical challenges. Our study aims at evaluating gender and age-based differences in the presentation and outcomes among younger patients with premature CAD.

Methods
Using the National Readmission Database, we identified patients admitted between 2016 and 2019 with a primary diagnosis of acute myocardial infarction (AMI). We focused our analysis on premature CAD, defined as males aged less than 45 and females aged less than 55 at, the time of the AMI diagnosis. We investigated potential differences in the type of AMI presentations, interventions received, and mortality rates among these premature AMI patients.

Results
A total of 225,948 patients with premature CAD were identified, comprising 89,608 males and 136,340 females. ST-segment elevation myocardial infarction (STEMI) was a more common presentation among the younger population compared to older cohorts (33% vs. 26%, p<0.001). Importantly, males exhibited a higher incidence of STEMI than females (40% vs. 28%, p <0.001). Females with premature CAD were significantly less likely to undergo PCI compared to males (52% vs. 62%, p <0.001), even after adjusting for STEMI (OR 0.77, p<0.001). Additionally, female patients demonstrated higher mortality rates than males (2% vs. 1.6%, p <0.001), persisting even after age adjustment (OR 1.15, p 0.017). No significant differences in the length of stay, incidence of cardiogenic shock, and implantable cardioverter defibrillator placement were noted between males and females.

Conclusion
Our study showed that STEMI was more common in younger patients presenting with AMI. Males had higher STEMI rates, but females were less likely to undergo PCI after adjusting for STEMI. Females also had higher inpatient mortality. These findings highlight disparities that warrant further investigation to address potential gaps in care for young female AMI patients.