Objectives Women and men have been shown to have different prevalence, clinical presentations, and outcomes of coronary artery disease. It is unclear whether atheroma burden and characteristics of coronary plaques differ between genders.

Methods We performed IVUS assessments in 81 patients with ACS. IVUS analysis included qualitative and quantitative measurements. Clinical parameters and coronary imaging parameters obtained by IVUS were compared between men and women.

Results Men had more smoking than women (80% vs 4.8%, P < 0.01). Other clinical characteristics were not significantly different between men and women. Number of diseased vessels and culprit lesion locations were statistically similar between men and women. Minimal lumen area (3.45 ± 1.39 vs 3.85 ± 2.55mm²), external elastic membrane (13.73 ± 5.00 vs 15.28 ± 6.53mm²), plaque area (10.27 ± 4.86 vs 12.01 ± 5.21mm²), and plaque burden (0.73 ± 0.11 vs 0.81 ± 0.11) were not significantly different between men and women. Women had less plaque rupture compared with men (23.8% vs 51.7%, P < 0.05). In 32 patients without smoking, women still had less plaque rupture compared with men (20% vs 50%, P < 0.05).

Conclusions Men and women had similar plaque burden, and women had less plaque rupture compared with men in ACS patients.