Background Coronary artery disease (CAD) is generally considered as a disease of middle-aged men.It is widely accepted that the risk for CAD of premenopausal women is low because of hormone protection.Based on our clinical experience，more and more premenopausal women suffer from angina and myocardial infarction without adequate conc.Even now，there are still limited detailed data to describe the characteristics，mechanism and prognosis of premenopausal CAD patients.This article aimed to analyze the clinical and angiographic characteristics of premenopausal women with CAD.Methods A total of 565 premenopausal women and 721 postmenopausal women (56-60 years old) who underwent coronary angiography for the first time from April 2004 to December 2007 were enrolled.The clinical data and coronary angiographic characteristics (presence，localization，length and severity) were compared between the premenopausal and postmenopausal CAD groups.Results Premenopausal CAD patients presented less frequently with hypertension，diabetes mellitus and dyslipidemia compared with postmenopausal CAD patients (55.0% vs 66.0%，15.0% vs 31.5%，23.9% vs 37.4%，respectively; all P<0.05).Although we found more frequent involvement of single vessel in premenopausal CAD (43.2% vs 26.9%，P=0),and triple vessels in postmenopausal (56-60 years old) CAD patients (33.8% vs 20.4%，P=0)，much more severe lesions (≥90%) at left main (2.9% vs 1.1%,P=0.048) and proximal left anterior descending artery (LAD) (28.2% vs 16.6%，P=0) in the premenopausal CAD group were found.Conclusion Premenopausal women with chest discomfort are always found to have obvious atherosclerosis，more inclined to be located at the left main and proximal LAD，which is a strong predictor of an adverse clinical outcome.