Differences in men and women in acute coronary syndromes

According to the World Health Organization, cardiovascular disease is the main cause of death and is expected to cause more than 23.6 million deaths till 2030. The incidence of acute coronary syndromes (ACS) is lower in women than men in all ages. While the overall cardiovascular mortality is higher in men than women, this difference appears to be eliminated in the last decade as men show a decrease with corresponding female increased mortality associated with coronary artery disease. However, the effect of the acute myocardial infarction (AMI) in younger women has increased and it may exhibit a higher risk of death compared to young men. Generally women presented more often with AMI without ST elevation (NSTE-ACS) or unstable angina and less often with ST segment elevation (STEMI) compared to men. From pathophysiological aspect the use of newer invasive and noninvasive imaging techniques such as coronary artery grayscale-IVUS, VH-IVUS, OCT showed differences in acute coronary events between men and women. In particular, women have smaller arteries and therefore smaller plaque burden required for clot coronary disease events and further may have a higher restenosis risk. In addition, women have a lower plaque burden, compared to males at all ages but culprit lesions are similar in OCT in both sexes. Autopsy studies have shown that the erosion compared to the plaque rupture is the principal mechanism of coagulation and erosion occurs more often in younger women. In women <65 years old the not culprit lesions are fewer and with less focal atheromatosis and plaque ruptures in relation to men, while the difference is smoother after 65 years. Regarding the nonatherosclerotic mechanisms of the ACS seems that women have often microvascular and endothelial dysfunction resulting in recurrent angina, hospitalizations and heart failure. Women with acute myocardial infarction (AMI) with elevation of the ST (STEMI) compared to men are older,