From Risk Factors to Revascularization: A Hospital-based Study of Acute Coronary Syndrome in Women

Objectives: Acute coronary syndrome (ACS) remains a major public health concern. Sex-related disparities in its clinical presentation, management, and prognosis have been recognized. However, data from the Maghreb region are limited. This study aims to explore sex-based differences in ACS in a Moroccan tertiary hospital. Materials and Methods: We conducted a retrospective, single-center study at Sheikh Zayd International University Hospital between 2021 and 2023, including 344 patients hospitalized for ACS. A comparative analysis between men and women was performed regarding demographic characteristics, cardiovascular risk factors, clinical presentation, diagnostic findings, management strategies, and in-hospital complications. Results: Among the patients, 103 were women (30%). Women were significantly older (mean age: 67.4 vs. 60.3 years, P < 0.001) and had higher rates of hypertension (74% vs. 50%, P < 0.001) and diabetes (60% vs. 42%, P = 0.003), but were less frequently smokers (3% vs. 52%, P < 0.001). They presented more often with atypical symptoms (47% vs. 20%, P < 0.001) and showed a higher incidence of heart failure signs on admission (Killip ≥2: 36% vs. 22%, P = 0.012). Non-ST elevation ACS was more frequent in women (62% vs. 44%, P = 0.003). Coronary angiography revealed a higher rate of normal or non-obstructive coronary arteries in women (24% vs. 9%, P = 0.001). Although percutaneous coronary intervention (PCI) was less frequent in women (65% vs. 79%, P = 0.012), there was no significant difference in in-hospital mortality (5.8% vs. 3.8%, P = 0.43). Conclusion: This study highlights significant sex-based differences in ACS. Women presented with more comorbidities, atypical symptoms, and were less likely to undergo PCI, despite similar short-term outcomes. These findings highlight the critical need for sex sensitive approaches in the diagnosis and management of ACS.