The purpose was to determine the differences between premenopausal and postmenopausal coronary artery disease (CAD) risk factors, clinical manifestation, cardiovascular features, rates of recurrence, and influencing factors.Premenopausal (n = 57) and postmenopausal (n = 178) CAD women hospitalized during the same period were enrolled. All patients were followed-up, and the combined recurrence of major adverse cardiovascular events was recorded as the clinical outcome. Differences were compared between the 2 groups.Fewer premenopausal women suffered from hypertension (43.86% versus 75.28%, P < 0.001), type 2 diabetes (12.28% versus 35.96%, P = 0.001), and hyperlipidemia (5.26% versus 34.83%, P < 0.001), but more had a positive family history of premature CAD (40.35% versus 25.28%, P = 0.03). Acute coronary syndrome (ACS) was more frequently seen in premenopausal women (82.46% versus 48.88%, P < 0.001), and their left anterior descending branch was the vessel most often involved (65.33%). The cumulative recurrence rate was 1.76 times higher in postmenopausal patients than premenopausal patients. Clinical diagnosis (HR = 2.54, 95%CI: 1.21-4.85, P = 0.02) and type 2 diabetes (HR = 4.10, 95%CI: 2.37-8.83, P = 0.004) were two factors that influenced recurrence in premenopausal subjects, while the clinical diagnosis (HR = 1.93, 95%CI: 1.59-3.46, P = 0.03) and Gensini score (HR = 1.20, 95%CI: 1.11-1.45, P = 0.02) were influencing factors in the postmenopausal patients.Symptoms among younger women were atypical, but the onset of disease was faster and more urgent, and angiography in premenopausal women might underestimate the severity of disease. The risk factors, rate of recurrence, and influencing factors were different between premenopausal and postmenopausal patients.