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DOI: 10.5935/abc.20180210 Coronary artery disease (CAD) was considered, for years, a "male disease”, a concept that influenced diagnostic and clinical decision-making processes.1,2 However, currently there is consistent evidence showing that CAD is a leading cause of death in women. On the basis of pooled data from studies of the National Heart, Lung and Blood Institute (1995–2012), it is estimated that within one year after a first myocardial infarction, 18% of males and 23% of females will die, and the median survival time is, at ≥ 45 years of age, 8.2 years for males and 5.5 for females.3 The underestimation of cardiovascular risk among women frequently resulted in a more conservative treatment and contributed to poorer outcomes.4 In the last decade, several studies have assessed the issue of gender disparities in the diagnosis, treatment, and outcomes of acute coronary syndromes (ACS).2,4 In this context, the study by Soeiro et al.5 contributes to the understanding of this issue by presenting data from a Brazilian registry of ACS. In this multicenter registry, the primary endpoint was in-hospital, all-cause mortality, and the secondary endpoint was the combination of cardiogenic shock, death, reinfarction, ischemic stroke and bleeding during a mean follow-up of 8 months. Just like any registry, it has limitations, such as the absence of data on other diseases like cancer, as well as on the differences in post-discharge management, adherence to treatment, among others, all which might influence survival in any group. Nonetheless, it has a large number of patients (2,437 men and 1,308 women) and may offer an interesting view of the Brazilian scenario of gender differences in ACS. Of note, at presentation, women less often had ST-elevation and multivessel CAD than men, but were older and more frequently diabetic, dyslipidemic and hypertensive. These data are in line with other studies.6 Unfortunately, data on symptoms at presentation are not available. It is known that, in ACS, women are less likely to present with classical angina symptoms, which may lead to under and/or misdiagnoses in women, and in turn may explain the worse outcomes, particularly in younger women.6,7 Accordingly, in the present study, it was noteworthy that percutaneous coronary interventions and coronary artery bypass grafting were more frequently performed in men than in women.

Gender Disparities and Outcomes Of Acute Coronary Syndromes In Brazil