Mortality rate differences observed between men and women presenting with acute myocardial infarction (AMI) have been the focus of clinical trials and registry analyses over the past two decades. Despite advances in cardiovascular therapies over this time, studies have shown that women presenting with AMI have increased early mortality compared to their male counterparts. The cause of mortality discrepancy after AMI in women has been the subject of much debate and has become one of many areas of interest regarding sex-specific outcomes in cardiovascular disease (CVD). Research suggests potential baseline risk profile differences and treatment biases among women compared to men as a reason for the AMI mortality gap. While the exploration of gender differences in coronary artery disease (CAD) has increased, the low proportion of female patients included in CVD trials as well as the lack of published studies results sorted by sex, leaves this an area in need of further study. The current issue of EuroIntervention includes two papers addressing this topic. Both studies assessed different European populations for gender-related differences in mortality after STsegment elevation myocardial infarction (STEMI) and come to the conclusions that female gender is an independent predictor of inhospital mortality following AMI. Benamer et al analysed 16,760 patients (3,664 women) treated by PCI for STEMI from 2003 to 2007 in the CARDIO-ARHIF registry and determined that women tended to be older, had more diabetes, were more likely to present in cardiogenic shock and had a lower success rate of PCI when compared to men. After multivariate logistic regression adjusted for these risks, the authors concluded female gender was associated with higher in-hospital mortality (OR 1.38 [1.16-1.63], p=0.0002) but only after age of 75. Sadowski and colleagues analysed 26,035 consecutive patients (8,989 women) with STEMI enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS). Like Benamer’s study, Sadowski et al determined these women were older with higher incidences of comorbidities such as hypertension, diabetes, obesity (BMI>30kg/m) and cardiogenic shock at presentation compared to males, and found a higher in-hospital mortality (1.13 [1.01-1.26], p<0.03), but not 12-month mortality (1.02 [0.96-1.09], p=NS) after multivariate adjustment. Given the data presented from these two studies, three important issues need further discussion. First, CVD is the most common cause of death among women, yet women remain poorly represented in randomised clinical trials investigating cardiovascular disease and treatment. As a society we have enjoyed a steady reduction in age-adjusted mortality for CVD, but only recently has the rate of mortality decline for women approached that of men. Reasons for this delay may include less frequent use of revascularisation procedures or evidence-based therapies in female patients with CVD. Others postulate an overall lack of awareness of the prevalence of CVD in women, on the part of patients, policy makers and healthcare professionals. A 2005 online survey of primary care physicians, gynaecologists and cardiologists found that fewer than 20% of physicians were aware that more women die annually of CAD than men – a finding that highlights the need for awareness campaigns among healthcare providers. There is a paucity of well-designed clinical trials assessing outcomes in women with cardiovascular disease and as a result, women have been under-represented in CVD clinical trials. In early studies investigating therapies employed in the treatment of AMI, fewer than 20% of subjects were women. Reasons for this