Acute Coronary Syndromes in Women and Men

Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Emerging data indicates that there are relevant sex-specific differences in the pathobiology, clinical presentation, and management of ACS in women and men. Premenopausal women appear to be largely protected from typical ACS, with women presenting 5 to 10 years later than men. Females tend to experience chest pain or discomfort less frequently and more often present with other associated symptoms, which may contribute to longer prehospital delays and less frequently administered guideline-directed care. Indeed, females are less likely to undergo coronary angiography and percutaneous coronary interventions, and less likely to get a prescription for statins after the acute event. Over the past decades, we made remarkable progress in ACS treatment, reducing short-term mortality from far above 50% to below 10% in both women and men. Novel risk tools for clinical risk assessment such as the machine learning-based GRACE 3.0 risk score may help to further improve the management of female and male non-ST segment elevation ACS patients. In this review, we discuss the role of sex in the diagnosis, management, and outcomes of patients with ACS.