• acute coronary syndromes

Sex differences in the clinical presentation of patients with chest pain and acute coronary syndromes (ACS) are well known. Even so, sex disparities persist in management and outcomes of women with chest pain. To better understand whether sex-differences in the initial assessment of patients with non-traumatic chest pain contribute to later adverse clinical outcomes, Mnatzaganian and colleagues1 retrospectively analysed data on 54 138 adults presenting to three emergency departments (EDs) in Melbourne with non-traumatic chest pain. On multivariable analysis, women (49% of patients) were 18% less likely to be triaged as urgent, 16% less likely to be examined by a physician within 1 hour, 20% less likely to have a troponin measured and 36% less likely to be admitted to a specialised care unit. Yet, these women clearly were even sicker than the men with a 35% higher risk of death in the ED and a 36% higher risk of death during that hospitalisation. (figure 1)

As stated so clearly in the accompanying editorial by Mackay2 : ‘these discouraging findings should …