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 Coronary artery disease (CAD) follows a different pattern in women and men, more so in the young (&lt; 40 years). The gender differences in the risk factors, clinical presentation and diagnosis need to be understood, so that appropriate and timely treatment can be given.  Objective The study contemplates to analyze the gender differences in the presence of major coronary risk factors, clinical presentation, diagnosis and immediate outcomes in patients who present with premature CAD (PCAD).  Patients and Methods We evaluated 1,062 consecutive registry patients who presented with diagnosis of PCAD between 2018 to 2019 at our institution after satisfying the inclusion criteria.  Results The study analyses 82 females and 980 males. The mean age of females was 35.4 ± 4.68 years and males was 34.2 ± 4.25 years. Males smoked more often (55.1%, p &lt; 0.001). Females more often had abnormal BMI (84.1%, p &lt; 0.001), increased waist-hip ratios (97.6%, p &lt; 0.001), diabetes (35.4%, p &lt; 0.001), dyslipidemia (17.1% vs. 11%) and hypertension (15.9% vs. 11.5%). STEMI was the most common presentation among males (80.4% vs. 71.9%). Majority of females (74.6%) presented 6 hours after index pain. NSTEMI was more common among females (20.7% vs. 16%). Single-vessel involvement was common in both sexes (84.1% in males and 85.2% in females). Obstructive CAD was less common in both groups.  Conclusions Conventional risk factors play a major role for CAD in Indians. Smoking was common in males and metabolic syndrome in females. Also, females had a higher threshold for seeking treatment and referral. Measures have to be taken for early diagnosis and referral of females. Recanalized and thrombotic coronaries were common, indicating predominant thrombus burden in the young

Gender Differences in South Indians with Premature Coronary Artery Disease (< 40 Years)—Insights from the PCAD Registry