A pioneering Argentinean study to better understand the regional gender differences on patients with Acute Coronary Syndromes.

Cardiovascular disease is well recognized as the leading cause of death in women. It is estimated that the lifetime risk for developing coronary artery disease (CAD) in women after 40 years of age is 32% (1) Acute coronary syndromes (ACS), including unstable angina (UA), non– ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), represent a large portion of the clinical presentation of CAD. ACS it presents in different aspects, and gender is linked to many aspects of these presentations. The reason for gender differences in ACS presentation is likely multifactorial. These differences include, clinical presentation, delay to diagnosis and treatment, accuracy of diagnostic tests, differences in biomarkers, angiographic features, administration of antiplatelet therapies, drug side effects, and higher procedural complications. Previous studies have shown gender differences at each step along the treatment path for ACS patients, especially, women who had an acute myocardial infarction were less likely than men to be admitted to hospitals with revascularization capability (2). They have also demonstrated that in this high-risk population, women were offered cardiac catheterization and percutaneous coronary intervention (PCI) less frequently than men (3,4). The results from the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO) IIb study (5) showed that women present significantly more often than men with UA/ NSTEMI and often with atypical features. These differences may be accounted for by differences in anatomy, pathophysiology of CAD, for the underutilization of acute antiplatelet therapy on hospital admission, and clinical characteristics in women vs men. In addition, there are conflicting data from randomized trials about the benefit of early invasive treatment in women (6-8). The data of 3100 female patients enrolled in the Euro Heart Survey ACS showed that female gender in the “real world” was not independently associated with worse in-hospital mortality, irrespective of the type