SYNTAX Score Research Articles

Ten-year survival benefit and appropriateness of surgical versus percutaneous revascularization in synergy between percutaneous coronary intervention with Taxus and cardiac surgery randomized trial.

Average treatment effects from randomized trials do not reflect the heterogeneity of an individual's response to treatment. This study evaluates the appropriate proportions of patients for coronary artery bypass grafting, or percutaneous intervention based on the predicted/observed ratio of 10-year all-cause mortality in the SYNTAX population. The study included 1800 randomized patients and 1275 patients in the nested percutaneous (n = 198) or surgical (n = 1077) registries. The primary end point was 10-year all-cause mortality. The SYNTAX score II-2020 was validated internally in the randomized cohort and externally in the registry cohort. Proportions of patients with survival benefits from coronary artery bypass grafting or percutaneous intervention were determined using SYNTAX score II-2020. Ten-year mortality was 23.8% for coronary artery bypass grafting, 28.6% for percutaneous intervention in the randomized cohort, 27.6% for coronary artery bypass grafting and 55.4% for percutaneous intervention in the registries. In the coronary artery bypass grafting registry, the SYNTAX score II-2020 predicted 10-year mortality with helpful calibration and discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The proportion of patients deriving a predicted survival benefit from coronary artery bypass grafting over percutaneous intervention was 82.4% (2143/2602) and 17.7% (459/2602) for the entire SYNTAX trial population, translating into a 4.7 to 1 appropriate ratio of treatment allocation to coronary artery bypass grafting and percutaneous intervention. Choosing a revascularization modality should depend on an individual's long-term prognosis rather than average treatment effects. Additionally, patients should be informed about their predicted prognosis. Registered on clinicaltrial.gov. NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050). NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).

Prognostic Role of Functional SYNTAX Score Based on Quantitative Flow Ratio

Prognostic Role of Functional SYNTAX Score Based on Quantitative Flow Ratio

Utilization of SYNTAX Score II for Predictive Clinical Outcomes in Patients with Coronary Artery Disease and Chronic Renal Insufficiency Following Percutaneous Coronary Intervention.

The SYNTAX score II (SS II) has earned widespread recognition for use on individuals with coronary artery disease (CAD) due to its reliable predictions of 4-year all-cause mortality (ACM). This research focuses on substantiating the prognostic significance of using the SS II for patients experiencing concurrent chronic renal insufficiency (CRI) and CAD who have undergone percutaneous coronary intervention (PCI). This study retrospectively examined 2468 patients with concurrent CAD and CRI who underwent PCI. Based on their SS II, these participants were sorted into low-, medium-, and high-risk groups and monitored over a median of three years. The evaluation of the predictive precision of different SYNTAX scores for clinical outcomes in patients with CRI after PCI involved using time-dependent receiver operating characteristic (ROC) curves. These included the standard SS (SS), SS II, clinical SS (CSS), and residual SS (rSS). The primary outcomes were ACM and cardiac mortality (CM), while the secondary outcomes covered major adverse cardiovascular and cerebrovascular events (MACCEs), stroke, unplanned revascularization, and myocardial infarction (MI). Higher 5-year cumulative incidences of MACCEs, MI, CM, and ACM were observed significantly in patients in the high SS II category relative to those in the low and medium SS II categories. Multivariable Cox regression analysis confirmed that the SS II independently predicts ACM, CM, MI, and MACCEs as a prognostic marker. Additionally, the analysis of the time-dependent ROC curve demonstrated that the areas under the curve (AUC) for predicting CM and ACM were 0.772 and 0.767, respectively, which are superior to those of other SYNTAX scores (p < 0.05). As an independent predictor, the SS II is notable for its ability to forecast long-term adverse outcomes, including MACCEs, CM, ACM, and MI. For patients with coexisting CAD and CRI undergoing PCI, it provides significantly improved prognostic accuracy for 5-year ACM and CM compared to other SYNTAX scores.

Prognostic value of pan immune-inflammation value in patients undergoing unprotected left main coronary artery stenting.

Aim: This study aimed long-term prognostic factors for percutaneous coronary intervention (PCI) in left main coronary artery (LMCA) disease, focusing on inflammatory parameters like Pan Immune-Inflammation Value (PIV) and Systemic Immune-Inflammation Index (SII).Materials & methods: This retrospective, observational study involved 121 patients receiving unprotected LMCA PCI.The study's primary end point was MACE, including all-cause death, repeat revascularization and myocardial reinfarction.Results: The PIV and SII scores emerged as independent predictors of MACE occurrence in patients undergoing PCI for unprotected LMCA disease (p:0.045,p:0.048;respectively).In addition, age, ejection fraction, creatinine, shock presentation and the residual syntax score were identified as significant independent predictors of MACE in both models.Conclusion: This study showed a significant, independent correlation between PIV, SII and MACE in patients undergoing PCI for LMCA disease, with PIV showing slightly better predictive capability than SII.

Triglyceride-Glucose Index: Evaluation as a Potential New Risk Marker for SYNTAX Score in Acute Coronary Syndrome

Triglyceride-Glucose Index: Evaluation as a Potential New Risk Marker for SYNTAX Score in Acute Coronary Syndrome

Association between the triglyceride-glucose index and the severity of coronary artery disease in patients with type 2 diabetes mellitus and coronary artery disease: a retrospective study

Background Type 2 diabetes mellitus (T2DM) is a primary contributor to coronary artery disease (CAD). Insulin resistance (IR) is a hallmark of T2DM and a significant risk factor for the progression of CAD. The triglyceride-glucose (TyG) index is a new alternative indicator to identify IR. We aimed to explore the association between the TyG index and severity of CAD in patients with T2DM. Methods 280 inpatients with T2DM were enrolled from November 2019 to November 2022, classified into the CAD group (n = 175) and non-CAD group (n = 105). The TyG index and SYNTAX score were calculated. According to SYNTAX score, patients were further classified into the mid-CAD group (n = 97) and moderate to severe CAD group (n = 78). Results A significant positive correlation between the TyG index and SYNTAX score was found in the CAD group (r = 0.70, p < 0.01). The TyG index predicted the presence of moderate to severe CAD significantly, and the area under the ROC curve was 0.79 (95% CI: 0.71-0.85, p < 0.01). The higher LDL-C and TyG index, the higher risk of developing moderate to severe CAD (OR = 4.40, 95% CI 1.28 − 15.16, p = 0.02; OR = 9.00, 95% CI 3.69 − 21.96, p < 0.01). Conclusions There was a significantly positive correlation between the TyG index and SYNTAX score in T2DM patients who developed CAD; the TyG index could predict a mid/high SYNTAX score (≥ 23) and increase the risk of moderate to severe CAD.

Assessment of the SYNTAX Score II in Patients with Non-ST Elevation Myocardial Infarction Who Have Coronavirus Disease-2019

Assessment of the SYNTAX Score II in Patients with Non-ST Elevation Myocardial Infarction Who Have Coronavirus Disease-2019

Long-term health outcomes of young patients with low-complexity coronary disease: a weighted analysis according to revascularization strategy.

Age is an important factor weighing on revascularization decisions. We analysed long-term health outcomes of young patients with low-complexity coronary anatomy suitable for both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), according to revascularization strategy. Patients 60 years old or less, undergoing invasive coronary angiography between January 2007 and December 2015, presenting with proximal left anterior descending artery involvement, left main or multivessel disease and a SYNTAX Score ≤22 were retrospectively selected. An inverse probability of treatment weight methodology generated a pseudopopulation with well-balanced characteristics, which was used to estimate the average treatment effect between PCI (n = 374) and CABG (n = 173). Mean age was 53 ± 7 years old, 27% had diabetes mellitus and 48% presented with an acute coronary syndrome. Mean SYNTAX score was 13.6 ± 4.9 and 68% underwent PCI as index revascularization strategy. In the weighed population, the adjusted hazard of the primary end-point of all-cause death at total follow-up (median 9.3 years; interquartile range 6.9-11.7) was 0.40 (95% confidence interval 0.19-0.7) for CABG vs PCI (incidence rate 5.8 vs 14.0 deaths/1000-person-years). Accounting for death as competing risk, the cumulative hazard of new revascularization (sub-distribution hazard ratio 0.72; 95% confidence interval 0.32-1.25) and any cause hospital readmission (sub-distribution hazard ratio 0.70; 95% confidence interval 0.41-1.07) were lower in CABG patients, as opposed to death/stroke rates at 30 days which were higher with CABG (0.3% vs 1.7%; risk ratio = 5.84). In this quasi-experimental analysis of young patients with coronary artery disease and an equivalent indication for both PCI and CABG, long-term health outcomes were favourably associated with CABG, as compared to PCI. These observations support the need for dedicated randomized trials with longer follow-up in order to better inform lifetime treatment options.

Diffuse idiopathic skeletal hyperostosis is associated with greater complexity of coronary artery disease burden on coronary angiography.

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder characterized by ossification of tendons and ligaments. DISH has been largely associated with an increased risk of metabolic syndrome and type 2 diabetes. The objective of the present study is to investigate the role of DISH on the risk of coronary artery disease (CAD). We conducted an observational cross-sectional study of patients without a history of rheumatic musculoskeletal diseases who underwent coronary angiography between March 2016 and April 2021. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score was calculated based on coronary angiography images. DISH diagnosis was based on standard X-ray images and computed tomography scans (Resnick criteria). Demographic and clinical characteristics were retrieved from electronic medical records. Multinomial and binary logistic regression models were employed to determine the association between SYNTAX score (dependent variable) and DISH (independent variable). The study included 187 patients, 82.9% of whom were men, with valid radiological imaging. 83 (44.4%) patients had a confirmed radiological diagnosis of DISH. Diagnosis of DISH was associated with a higher SYNTAX score [adjusted odds ratio (aOR) 34.1, 95% confidence interval (CI) 1.41-79.2 p=0.049], independently from traditional cardiovascular risk factors. In patients aged <70 years, DISH was associated with a 7-fold higher risk of belonging to the highest category of SYNTAX (≥34), compared to non-DISH (aOR 7.23, 95% CI 1.08-48.4; p=0.041). The extension of vertebral calcification was significantly associated with SYNTAX score (r2 0.378, p<0.0001). DISH diagnosis is common in patients at high risk of cardiovascular disease or with definitive CAD. DISH was independently associated with higher CAD complexity.

TCT-176 Comparative Analysis of Predictive Accuracies of SYNTAX and SYNTAX-II Score for Mortality and Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

TCT-176 Comparative Analysis of Predictive Accuracies of SYNTAX and SYNTAX-II Score for Mortality and Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

TCT-76 Percutaneous Coronary Intervention in High-Risk Patients With High Syntax Score Left Main Coronary Disease: 17-Year Long-Term Follow-Up Real World Experience of a Single Center Without On-Site Cardiac Surgery

TCT-76 Percutaneous Coronary Intervention in High-Risk Patients With High Syntax Score Left Main Coronary Disease: 17-Year Long-Term Follow-Up Real World Experience of a Single Center Without On-Site Cardiac Surgery

Correlation Between Complexity of Coronary Lesions and Delta High-sensitivity Troponin (hs-cTn) I Levels in Patients of Non-ST Elevation Myocardial Infarction

Non-ST Elevation Myocardial Infarction is a critical condition where early identification of myocardial injury is essential for risk stratification and treatment. High-sensitivity cardiac troponin I (hs-cTnI) is a well-established biomarker for detecting myocardial damage. Objectives: To assess the association between Syntax scores and initial significant delta hs-cTnI in patients who had been hospitalized with Non-ST Elevation Myocardial Infarction. Methods: Observational cohort study from January 2022 to December 2022 involving a total of one hundred and fifty patients admitted at Hayatabad Medical Complex Peshawar. hs-cTnI on admission and at 1, 2 hours and between (6h-12 h) post-admission daily was measured. Coronary lesion complexity was assessed with Syntax scores according to the results of coronary angiography. Statistical Analysis of data was performed using Pearson correlation to analyze the association between syntax scores delta hs-cTnI levels. Results: SYNTAX scores were correlated with Δhs-cTnI levels at all-time points, and the strongest correlation was found 6-12 hours post-admission (r=0.78). The syntax score had a mean value of 24.11 ± 14.74, and hs-cTnI levels increased over time to reflect the extent of myocardial injury. Conclusions: It was concluded that in Non-ST Elevation Myocardial Infarction patients, Syntax scores demonstrating more complex coronary lesions are related to higher delta hs-cTnI levels. This value highlights the use of hs-cTnI as a biomarker to evaluate the severity of myocardial injury and direct clinical decision-making in Non-ST Elevation Myocardial Infarction. Delta hs-cTnI measurements in diagnostic and risk stratification algorithms may lead to enhanced early identification of disease with improved outcomes.

The Relationship between Serum Calcium Levels and Angiographic Severity of Coronary Artery Disease in Patients with Chronic Coronary Syndrome

Objectives: This study aims to investigate the relationship between serum calcium levels and the angiographic severity of coronary artery disease (CAD) in patients with chronic coronary syndrome (CCS). Methodology: We conducted an observational study at the Department of Cardiology, Hayatabad Medical Complex, from January 2022 to December 2022, including 150 patients diagnosed with CCS. Serum calcium levels were measured using a colorimetric method, and the severity of CAD was assessed using the SYNTAX score derived from coronary angiography. Statistical analyses were performed using Pearson’s correlation coefficient and multivariate logistic regression to account for potential confounding factors such as age, gender, hypertension, diabetes, and dyslipidemia. Results: The analysis revealed a low negative correlation between serum calcium levels and SYNTAX scores (correlation coefficient: -0.13). Age emerged as a significant predictor of CAD severity (p&lt;0.001), whereas serum calcium levels did not demonstrate an independent effect on CAD severity (p=0.24). After adjusting for confounding variables, no substantial correlation between serum calcium levels and SYNTAX scores was observed. Conclusion: While serum calcium levels were not independent predictors of CAD severity after adjusting for other risk factors, a weak negative correlation was observed. Age remained a crucial factor influencing CAD severity. These findings suggest that serum calcium levels alone are insufficient for CAD risk classification but may provide additional value when used in conjunction with other diagnostic methods.

IMPACT OF LESION COMPLEXITY ON PCI SUCCESS IN LAD DISEASE: A RETROSPECTIVE STUDY

Coronary artery disease (CAD) involving the left anterior descending (LAD) artery is a major cause of morbidity and mortality globally. The prognosis of patients with coronary artery disease depends on the extent of at-risk myocardium. LAD comparatively supplies a large percentage of the left ventricle compared to RCA or LCX. The principal indication of percutaneous coronary intervention is to improve the quality of life in patients with angina refractory to medications. There are many advancements in PCI techniques for better management of challenging lesions due to physiological, anatomical, or functional difficulties. Some of the complex lesions include ostial lesions, bifurcating lesions, calcified lesions, and chronic total occlusions. However, as lesion complexity plays a significant role in procedural success and long-term outcomes, complex lesions are often associated with increased rates of restenosis, adverse events, and procedural challenges Objective: This study aims to evaluate the impact of lesion complexity on PCI success in patients with LAD disease. Methods: This retrospective cohort study was conducted from January 1, 2021, to December 31, 2023, at a tertiary cardiovascular center. A total of 216 participants who had PCI to LAD lesions done were included. Lesion complexity was assessed using the SYNTAX score and categorised into low, intermediate, and high complexity groups. The primary outcome was restenosis at 12 months, defined as ≥50% luminal narrowing in patients requiring repeat angiography due to any indication. Secondary outcomes included procedural success, major adverse cardiac events (MACE), and rates of stent thrombosis. Data were analysed using SPSS version 24.0, with statistical significance set at p &lt; 0.05. Results: Among the 216 participants, 72% were male, and the mean age was 61.4 ± 9.8 years. Restenosis occurred in 13.9% of participants, with higher rates observed in patients with high-complexity lesions (24.5%) compared to low-complexity lesions (7.7%) (p = 0.02). Procedural success was achieved in 92.6% of cases, though it decreased with increasing lesion complexity (97.8% for low, 93.4% for intermediate, and 85.7% for high-complexity groups). MACE occurred in 4.6% of participants, with stent thrombosis noted in 2.7%. Conclusion: Lesion complexity significantly influences PCI success and restenosis rates in LAD disease. Patients with higher complexity lesions experience worse outcomes, necessitating individualised treatment strategies to optimise procedural success.

Investigation of TLR4, TLR6, TLR7, and CD36 expression on T lymphocytes in coronary artery disease

Background: Coronary artery disease (CAD) is among the significant causes of death globally, caused by fatty deposits in blood vessel walls. Increasing evidence indicates that toll-like receptors (TLRs) are pivotal to atherosclerosis progression. The function of CD36 as a glycoprotein in atherosclerosis was also suggested. This study aimed to investigate the levels of TLR4, TLR6, and TLR7, as well as CD36 cell surface markers in CAD. Methods: This study included 64 patients undergoing angiography to determine whether atherosclerosis was present. The patients were categorized into two groups. The three main coronary arteries are all stenosed at over 50% in patients with CAD+ (n=22) as cases and CAD− (n=42) with smooth angiography as controls. Each patient's syntax score (SS) and Gensini (vessel score) were calculated. The TLR-4, TLR-6, TLR-7, and CD36 expression were measured using Flow cytometry. Results: TLR4 and TLR6 showed a significant link with the Gensini score in the subject group. In addition, TLR7 had an association with Syntax scoring in this study. Conclusion: The findings illustrated the association between TLR4, TLR6, and TLR7 cell surface markers with Gensini and Syntax scoring in individuals with coronary artery disease.

Prognostic Value of Quantitative Flow Ratio Combined with SYNTAX Scores I/II in Multivessel Coronary Artery Disease: A Small-Sample, Single-Center Study.

A fractional flow reserve (FFR)-fixed-SYNTAX score could decrease the number of high-risk patients. This study explored the prognostic value of non-invasive quantitative flow ratio (QFR)-fixed-SYNTAX I/II scores in multivessel disease patients. This was a single-center, small-sample, observational study. Multivessel coronary disease patients were enrolled and finished a 1-year follow-up. SYNTAX scores I/II and functional SYNTAX scores I/II based on QFR (cut-off value of 0.85) were calculated for all patients. The composite occurrence of cardiac deaths, any myocardial infarction, or ischemia-driven revascularization were analyzed using a different score system. A total of 160 patients were stratified into risk groups based on a different scoring system. FSS (functional SYNTAX score) and FSSII (functional SYNTAX score II) reduce the radio of high-risk major adverse cardiovascular events (MACEs), transforming the patients from high-risk to medium- and low-risk. Furthermore, FSSII (hazard ratio (HR): 1.069, 95% CI: 1.025-1.115, p = 0.002) showed a better relationship with MACEs than the other score systems. After recalculating SSII, the survival-free ratio stratified by FSSII decreased from 38.46% to 27.27% in the high-risk group and increased from 84.09% to 86.05% in the low-risk group. FSS or FSSII could decrease the number of high-risk patients compared to SYNTAX score (SS) and FSS. SYNTAX II score (SSII) and FSSII showed a better predictive ability than other scoring systems for under-risk stratification.

The relationship between the new inflammatory markers and disease severity in patients with acute coronary syndrome

Background Inflammation plays a crucial role in the progression of acute coronary syndrome. Aims The aim of this study was to investigate the relationship between the SYNTAX score and new inflammatory markers including albumin-globulin ratio (AGR), C-reactive protein-to-albumin ratio (CAR), fibrinogen-to-albumin ratio (FAR), neutrophil-to-albumin ratio (NAR), and neutrophil percentage-to-albumin ratio (NPAR) in STEMI and NSTEMI patients. Methods The study involved 53 STEMI and 64 NSTEMI patients, and each patient group was evaluated separately. Multivariate linear regression analysis was utilised to identify independent risk factors associated with SYNTAX scores. Results Out of the 64 NSTEMI patients, 42 had low SYNTAX score (65.6%), and 22 had high SYNTAX score (34.4%). Patients with high SYNTAX scores had significantly higher levels of age, glucose, fibrinogen, monocyte, and FAR, and lower levels of albumin and total protein. We found that FAR and monocyte levels were independent predictors of the high SYNTAX score. The study also determined that the cut-off value for FAR as 9.99, with a sensitivity of 81% and a specificity of 73% for predicting high SYNTAX score in NSTEMI patients. Out of the 53 STEMI patients, 42 had low SYNTAX score (79.2%), and 11 had high SYNTAX score (20.8%). Patients with high SYNTAX scores exhibited significantly higher total cholesterol, LDL, and glucose levels, and lower albumin and total protein levels. Conclusions The FAR level is significantly linked with the high SYNTAX score and can be a useful marker for predicting the severity of disease in NSTEMI patients.

Coronary Artery Disease among Type-II Diabetic Patient in Bangladesh

This study aimed to evaluate the relationship between microalbuminuria and the angiographic severity of CAD patients with type 2 diabetes by SYNTAX I, SYNTAX II, and Gensini scores. Diabetes mellitus is one of the strongest risk factors for coronary artery disease, so it is imperative to identify CAD in diabetic patients as soon as feasible. In this study, 82 patients with type II diabetes who had a suspected case of coronary artery disease (CAD) had elective coronary angiography. The urine albumin-creatinine ratio (UACR) was measured for each patient, and the severity of each patient's CAD was assessed using the Gensini, SYNTAX, and SYNTAX II scores. In the studied population, there were 26 (31.7%) females and 56 (68.3%) males. On average, they were 56.29 + 9.18 years old. Patients were categorized into two groups based on their UACR level: group 1 consisted of 41 patients whose UACR was less than 30 mg/g, and group 2 consisted of 41 patients whose UACR was greater than or equal to 30 mg/g. The study found that patients in group 2 had significantly higher SYNTAX scores (P=0.001) and significantly higher Gensini scores (P=0.001) than patients in group 1. Age and the length of UACR and DM showed a positive correlation (p=0.003), as did hypertension (HTN) and the length of UACR and DM (p=0.049). Microalbuminuria can be used to predict the severity and presence of CAD in type II diabetes. Keywords: Gensini score, SYNTAX score, microalbuminuria, diabetes, and coronary artery disease.

Serum BAFF level is associated with the presence and severity of coronary artery disease and acute myocardial infarction

ObjectiveThe aim of this study was to investigate the relationship between circulating levels of B cell activating factor (BAFF) and the presence and severity of coronary artery disease (CAD) and acute myocardial infarction (AMI) in humans, as its biological functions in this context remain unclear.MethodsSerum BAFF levels were measured in a cohort of 723 patients undergoing angiography, including 204 patients without CAD (control group), 220 patients with stable CAD (CAD group), and 299 patients with AMI (AMI group). Logistic regression analyses were used to assess the association between BAFF and CAD or AMI.ResultsSignificantly elevated levels of BAFF were observed in patients with CAD and AMI compared to the control group. Furthermore, BAFF levels exhibited a positive correlation with the SYNTAX score (r = 0.3002, P < 0.0001) and the GRACE score (r = 0.5684, P < 0.0001). Logistic regression analysis demonstrated that increased BAFF levels were an independent risk factor for CAD (adjusted OR 1.305, 95% CI 1.078–1.580) and AMI (adjusted OR 2.874, 95% CI 1.708–4.838) after adjusting for confounding variables. Additionally, elevated BAFF levels were significantly associated with a high GRACE score (GRACE score 155 to 319, adjusted OR 4.297, 95% CI 1.841–10.030). BAFF exhibited a sensitivity of 75.0% and specificity of 71.4% in differentiating CAD patients with a high SYNTAX score, and a sensitivity of 75.5% and specificity of 72.8% in identifying AMI patients with a high GRACE score.ConclusionCirculating BAFF levels serve as a valuable diagnostic marker for CAD and AMI. Elevated BAFF levels are associated with the presence and severity of these conditions, suggesting its potential as a clinically relevant biomarker in cardiovascular disease.

Sex Disparities in the Management of Acute Coronary Syndromes: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

Previous work has demonstrated disparities in the management of cardiovascular disease among men and women. We sought to evaluate these disparities and their associations with clinical outcomes among patients admitted with acute coronary syndromes to the Veterans Affairs Healthcare System. We identified all patients that were discharged with acute coronary syndromes within the Veterans Affairs Healthcare System from October 1, 2015 to September 30, 2022. Medical and procedural management of patients was subsequently assessed, stratified by sex. In doing so, we identified 76 454 unique admissions (2327 women, 3.04%), which after propensity matching created an analytic cohort composed of 6765 men (74.5%) and 2295 women (25.3%). Women admitted with acute coronary syndromes were younger with fewer cardiovascular comorbidities and a lower prevalence of preexisting prescriptions for cardiovascular medications. Women also had less coronary anatomic complexity compared with men (5 versus 8, standardized mean difference [SMD]=0.40), as calculated by the Veterans Affairs SYNTAX score. After discharge, women were significantly less likely to receive cardiology follow-up at 30 days (hazard ratio [HR], 0.858 [95% CI, 0.794-0.928]) or 1 year (HR, 0.891 [95% CI, 0.842-0.943]), or receive prescriptions for guideline-indicated cardiovascular medications. Despite this, 1-year mortality rates were lower for women compared with men (HR, 0.841 [95% CI, 0.747-0.948]). Women are less likely to receive appropriate cardiovascular follow-up and medication prescriptions after hospitalization for acute coronary syndromes. Despite these differences, the clinical outcomes for women remain comparable. These data suggest an opportunity to improve the posthospitalization management of cardiovascular disease regardless of sex.