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Coronary artery disease and acute coronary syndrome in women
  1. Julinda Mehilli1,2,
  2. Patrizia Presbitero3
  1. 1 Cardiology, University Hospital Munich, Munchen, Germany
  2. 2 German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany, Munich, Germany
  3. 3 U.O. Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milano, Italy
  1. Correspondence to Professor Julinda Mehilli, Cardiology, University Hospital Munich, Munchen 81337, Germany; julinda.mehilli{at}


There are important dissimilarities in clinical presentation, aggregation of comorbidities, cardiovascular risk factors and the quality of delivery of medical care among men and women with acute coronary syndrome (ACS). Compared with men, despite the well-known older age and more pronounced frailty, women with ACS present later from symptom onset and are at high bleeding risk after invasive procedures. In addition, autoimmune/inflammatory disease, fibromuscular dysplasia, polycystic ovary, early menopause and history of pre-eclampsia are risk factors preceding ACS among younger women. They more often experience myocardial infarction in the absence of obstructive coronary arteries (MINOCA), which makes diagnosis and treatment of ACS among women more challenging compared with men. Women and men do both benefit from guideline-recommended treatment, although, compared with men, women with ACS have a higher adjusted risk of early death, which equalises between both sexes within the first year. Young women with ACS suffer frequently of depression and present often with MINOCA. Compared with young men, they (young women) have a higher risk of death. Therefore, focusing on young patients with ACS, understanding the particular physiopathology of MINOCA and developing programmes targeting comorbidities and depression-related behavioural risk factors are urgently needed.

  • acute coronary syndromes
  • percutaneous coronary intervention
  • acute myocardial infarction

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  • Contributors Both authors contributed significantly to the conception, initial drafting and significant revision of the manuscript. JM is responsible for the overall content of it. JM wrote the first draft of the paper, PP revised it critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JM: institutional grant funding from Boston Scientific, lecture fees from AstraZeneca, Bristol-Myers Squib, Edwards Lifesciences, Medtronic, Boston Scientific, Siemens.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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