The study enrolled 7930 ACS patients from 65 hospitals in 6 Arabian Gulf countries, during the period of October 2008 to June 2009. Of these, 686 (8.7%) were 40 years of age or younger, with mean age of 36 +/- 4 years. Compared to older patients, the young patients had higher prevalence of STEMI (62% vs 42.9%, P<0.001) and male gender (91.3% vs 77.6, P<0.001). The major risk factor was smoking (61.5% vs 33.2%, P<0.001). Furthermore, the percentage of diabetes, hypertension and hyperlipidemia were significantly low in younger age group (18% vs 42.2%), (21.4% vs 50.2%) and (22% vs 38.9%), respectively. P<0.001). In addition, young patients were less likely to have heart failure on admission (10.5% vs 24.1%, P<0.001). No statistical significance was observed between the two groups in terms of in hospital morbidity except for congestive heart failure which was more predominant in older patients (6.1% vs 13.8%, P<0.001). The rate of coronary angiogram was significantly higher in younger patients (35.9% vs 32.2%, P=0.003). However, there was no statistical significance in PCI between the two groups (17.1% vs 14.2%, P=0.247). In ACS younger group in-hospital mortality rate (1.9% vs 4.8%, P<0.001), 30 days (4.4% vs 8.5%, P<0.001) and 1-year (5.7% vs 13.2%, P<0.001) were significantly lower than patients with ACS >40 years of age.