Risk stratification and health inequalities in women with acute coronary syndrome: time to move on

Abstract

Despite efforts since the early 1990s to understand ischaemic heart disease in women, many gender biases persist in acute coronary syndrome (ACS) care,1 which affect many patients each year. We know that, compared with men, women have longer delays to diagnosis and more atypical symptoms of ACS, especially younger women.2 In terms of diagnosis, upper reference limits for cardiac troponins in women are lower than those generally established for clinical decisions,3 and women present with specific angiographic findings (eg, myocardial infarction with non-obstructive coronary arteries or spontaneous coronary artery dissection).