Gender differences in management of patients with acute coronary syndromes (ACS) have been reported. The aim of this study was to evaluate the impact of gender on myocardial revascularization in patients with ACS from a French nationwide registry (ONACI).

We analysed data from a nationwide French prospective multicentre registry including 64,932 ACS patients (mean age 65.7±13.3; 27% women, 31% ST-elevation myocardial infarction (STEMI)) recruited in 99 centres between 2004 and 2008. Women were older than men and had higher rates of cardiovascular risk factors. Women were more likely to have normal vessel/non-significant coronary artery disease (<50% stenosis in all epicardial vessels; 8.4% vs. 3.8%, p<0.001) and less likely to have leftmain and three vessel disease. After adjustment for age, risk factor, and extent of disease, myocardial revascularization (defined as the use of percutaneous coronary intervention (PCI) or coronary artery bypass grafting) was less frequently used in women than in men (adjusted OR=0.83; 95% CI: 0.78-0.87). For those receiving PCI, In-hospital mortality occurring within 24 hours of intervention was higher in women (3.6% vs. 1.2%; adjusted OR=0.51; 95% IC: 1.22-1.87).

In the present study, women with ACS were likely to have cardiovascular disease risk factors, but were more likely to have normal vessel/non-significant angiographic coronary artery disease. In patients with advanced disease, myocardial revascularization seems to be less used in women compared to men whatever the type of ACS. Further study regarding long-term clinical outcomes according to sex and myocardial revascularization is warranted.