Feature Article

Acute coronary syndromes in women: different presentation and poorer outcomes

Peter L Thompson, Brendan M McQuillan



Despite being more likely to present with NSTEMI than STEMI, women have worse outcomes after an ACS than men, due in part to older age at ACS occurrence and having more comorbidities. Women generally have longer delays from symptom onset to treatment and are more likely not to report chest pain and less likely to have diagnostic ECG changes and elevated troponin levels.

Key Points

  • The widespread community perception that heart attack is a ‘man’s disease’ may contribute to longer delays in women presenting with suspected acute coronary syndrome (ACS).
  • Heart attacks are common in older women and urgent hospital transfer for effective management is vital.
  • Presentation of ACS in women can be atypical with dyspnoea, nausea and fatigue, rather than typical angina pain. Being alert to these atypical presentations avoids delays in treatment.
  • Takotsubo cardiomyopathy is far more common in women than in men. It is brought on by sudden emotional stress and usually resolves with a favourable prognosis.
  • Women have a worse prognosis after an ACS. It is not clear if this is due to later age at presentation, undertreatment or sex differences.
  • Women respond just as well as men to early reperfusion therapies for coronary occlusion, but if there are delays in diagnosis or treatment delivery, their outcome is worse.
  • Women receive less invasive treatments than men when they have an ACS. This may be appropriate because of older age and more comorbidities but this valuable form of treatment should not be denied because of diagnosis delays or gender bias.

    Picture credit: © BSIP/Alice S./Diomedia.com