Management of Acute Coronary Syndromes – Is the Vanishing of the Yentl Syndrome Accelerated in Hypertension?

Objective: The term Yentl Syndrome, coined by Bernadine Healy in 1991, refers to the disparities in the diagnosis and management of acute coronary syndromes between men and women. Using data from the Swiss nationwide AMIS Plus registry, we analyzed temporal trends of this gender gap in Switzerland with special emphasis on the presence of hypertension. Design and method: The AMIS Plus registry includes patients with acute myocardial infarction (MI) admitted to 62 Swiss hospitals, ranging from community to tertiary care centers. We analyzed gender differences in the use of percutaneous coronary intervention (PCI) across three consecutive 6-year periods (2007–2012, 2013–2018, 2019–2024) for ST-elevation MI (STEMI). Results: Between January 2007 and December 2024, 27,838 STEMI patients were enrolled. Of these, 21,021were men (75.5%) and 6,817 women (24.5%). Among 26,264 STEMI patients with available data 15,415 (55.4%) had hypertension. On average, hypertensive patients were eight years older (68.1 years, SD 12.4) than non-hypertensive patients (60.4 years, SD 12.6). (p<0.001), had more comorbidities (Charlson Comorbidity Index >1: 25% vs. 9%), and arrived at the hospital 39 minutes later than non-hypertensive patients. A significantly higher proportion of men than women underwent PCI in both hypertensive (91.5% versus 86.7%, p < 0.001) and non-hypertensive (95.1% versus 90.9%, p<0.001) patients. However, the gender gap in PCI use narrowed significantly over time. Among all STEMI patients, the gap decreased from 8.8% in 2007–2012, to 3.2% in 2013–2018, and 2.7% in 2019–2024. In STEMI patients with hypertension, gender gap declined across the three periods from 9.4% (p<0.001) to 2.4% (p=0.007) to 1.0% (p=0.323). In contrast, among STEMI patients without hypertension, no meaningful gender gap reduction in use of PCI was observed (4.4% to 3.6% to 4.6%) over the same periods. Conclusions: In this nationwide prospective registry, we observed a marked reduction in gender-related disparities in PCI use among STEMI patients in Switzerland between 2007 to 2024. This reduction was even more pronounced in hypertensive patients whereas in those without hypertension no significant reduction in the gender gap was observed.