Procedural outcome of coronary angioplasty in 89 patients < or = 40 years was compared to an older group of 1,916 patients > 40 years. Young patients were more often male (98% vs. 81%), smokers (89% vs. 70%), and more stressed (subjectively) (29% vs. 15%) compared to the older group. Other coronary risk factors were less common in the younger group: diabetes (5% vs. 13%), and hypertension (19% vs. 40%). Left ventricular function, number of diseased vessels, and the number and location of sites dilated were similar in the two groups. Procedural success rates were similar in the two groups (90% in young, 86% in old; p = NS). Younger patients suffered no major complications of the procedure, in contrast to a myocardial infarction rate of 5%, and urgent bypass surgery and mortality rates of 1% each in the older group. Young patients were followed up for a mean of 30 +/- 26 months after the procedure, with an actuarial 5-year survival of 100%. Four patients (5%) required elective coronary bypass surgery: two due to a failed angioplasty attempt (failure to cross), the other two for progressive multivessel disease. A total of 28 patients (34%) required re-angioplasty (restenosis: 13%, progression elsewhere: 12%, both: 9%). All re-angioplasty procedures were angiographically and clinically successful, with no major complications. For young patients, coronary angioplasty is a safe and effective procedure. If technically feasible, angioplasty should be considered the initial therapeutic option without neglecting risk factor modification.