Basis for sex-dependent outcomes in acute coronary syndrome

This review aims to provide new insights into the basis for sex differences in acute coronary syndrome (ACS). Sex differences in mortality after ACS depend on age and the type of ACS, with the greatest gap being observed among younger adults and patients with ST-segment elevation myocardial infarction (STEMI). The sex gap diminishes with increasing age and does not appear to exist to the same extent among patients with non-STEMI or unstable angina. Although it is clear that younger women with acute myocardial infarction have higher mortality than do men in the short term; whether this difference is present in the long term remains unclear. Furthermore, women with ACS face delays in diagnosis and treatment, undergo less invasive management, have more bleeding complications, and receive less evidence-based medical therapy than do their male counterparts. Finally, women with ACS consistently report lower health-related quality of life than do men. To date, our understanding of the sex differences in ACS remains limited. The impact of biological factors and nonbiological factors (especially gender roles) need to be explored to elucidate the disparities in health outcomes between men and women.