Diagnostic and Management Dilemmas in Women Presenting with Acute Coronary Syndromes

Abstract

Purpose of Review To summarize gender-and sex-specific differences in the presentation, diagnosis, management, and pathophysiology of women presenting with acute coronary syndrome (ACS). Recent Findings Sex differences exist in many aspects of ACS that impact the identification, treatment, and outcomes in women. There are delays in the initiation of care, under recognized diagnostic differences based on sex, and inconsistencies in the management of ACS in women compared with men, that ultimately impact outcomes. Additionally, women with ACS are more likely than men to present with non-obstructive coronary artery disease (CAD), which appears to be due to diverse underlying pathophysiology. Summary Women with ACS face diagnostic and treatment dilemmas from time of symptom onset to hospital discharge. Underrecognition, under-diagnosis, and under-treatment ultimately result in poorer outcomes in women. Underlying pathophysiologic differences in women require additional testing to elucidate underlying etiologies. Keywords Cardiovascular disease . Myocardial infarction . Acute coronary syndrome . Women . Sex differences . Myocardial infarction with non-obstructive coronaries (MINOCA) This article is part of the Topical Collection on Management of Acute Coronary Syndromes

An analysis of neuroscience and psychiatry papers published from 2009 and 2019 outlines opportunities for increasing discovery of sex differences

“…Harnessing the knowledge that males and females can differ on several disease-related outcomes will be fruitful in not only understanding disease but also in determining whether sex-specific risk factors for disease may warrant further attention. For example, sex differences in the manifestation of cardiovascular disease has prompted calls for changes to the diagnostic guidelines for cardiovascular disease based on sex 10 . To make headway for precision medicine and most effective treatment and diagnoses, sex must be taken into consideration in the design and analyses of data.…”

Tokyo Trends

“…Additionally, women remain undertreated with the rate of emergency intervention significantly lower despite an overall increase trend. 8 , 9 , 10 This is a problem that was first recognized in developed Western countries but, as this study shows, is likely prevalent also in Asia.…”

The Impact of Gender on the Postoperative Consumption of Intensive and Intermediate Care Resources

“…The observations also appear consistent with our thesis that women receive less aggressive care after presenting with cardiac symptomatology or history. Women are said to suffer from “under-recognition, under-diagnosis, and under-treatment” of coronary artery disease (Trutter et al, 2020). Further evidence for this thesis was demonstrated by a greater percentage of men having previously undergone coronary artery bypass surgery (30% vs. 6%) while more women had had previous percutaneous coronary interventions (50 vs. 36%).…”