International study findings highlight key differences between women and men presenting with acute coronary syndromes (ACS).

The results indicated that

• women presenting with ACS are more likely to have minimal coronary artery disease (CAD)
• which the authors say may partially account for different treatment choices in women compared with men.
• However, women are more likely than men to have cormorbidities such as hypertension and diabetes.

Researchers led by Sujoya Dey, from the University of Michigan in Ann Arbor, USA, studied 7638 women and 19,117 men enrolled in the Global Registry of Acute Coronary Events (GRACE) who were admitted to hospital with presumed ACS and underwent coronary angiography.

Women were, on average, older than men at presentation and had higher rates of prior angina, heart failure, diabetes, and hypertension, but were less likely to smoke.

In patients with documented myocardial infarction, chest pain was the most common symptom in both men (94%) and women (92%).

However, among those without chest pain, women were more likely than men to present with atypical symptoms including jaw pain (10% vs 4%, p<0.001) and nausea or vomiting (32% vs 23%, p=0.001).

Strikingly, angiographic data revealed that women were twice as likely as men to have normal or mild CAD (12% vs 6%, p<0.001), while they were less likely to have left-main or three-vessel disease (27% vs 32%, p<0.001) and to undergo percutaneous coronary intervention (65% vs 68%, p<0.01).

Among patients with advanced CAD:

• women had a higher risk for death (4% vs 3%, p<0.01) and
• were more likely to suffer death, myocardial infarction, stroke
• or rehospitalization at 6 months of follow-up than men (adjusted odds ratio 1.24).

Co-author Lisa Jackson, also from University of Michigan, commented: "We have two education challenges ahead, based on these data:

• Educating women that they should seek immediate attention for both the classic heart attack symptoms and atypical sudden symptoms
• and educating physicians that non-obstructive coronary artery disease is still disease and needs to be treated seriously."

Heart 2008; Advance online publication