Author + information
- Received November 12, 2015
- Revision received February 8, 2016
- Accepted February 11, 2016
- Published online April 1, 2016.
- Jaya Chandrasekhar, MBBS and
- Roxana Mehran, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Roxana Mehran, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Acute coronary syndromes (ACS) may result from atherosclerotic or nonatherosclerotic mechanisms, and commonly but not always present as plaque rupture. Women presenting with ACS are more often older than men with several pre-existing comorbidities. Although the protective influence of estrogen is notable in younger women, it is over-ridden by the presence of risk factors resulting in worse outcomes for young women with ACS compared with young men. Similarly the morbidity of angiographically nonobstructive disease is greater in women, leading to recurrent angina and hospitalization. ACS resulting from nonatherosclerotic mechanisms requires rigorous investigation for appropriate management. Although cost and logistics deter the routine use of invasive coronary imaging during cardiac catheterization, careful clinical considerations are warranted to guide optimal usage in practice. This review will discuss the insights into sex-based differences obtained chiefly from invasive coronary imaging with a focus on ACS.
- acute coronary syndrome
- endothelial dysfunction
- fractional flow reserve
- intravascular ultrasound
- invasive coronary imaging
- nonatherosclerotic mechanisms
- nonobstructive disease
- optical coherence tomography
- sex-based differences
Dr. Chandrasekhar has reported that she has no relationships relevant to the contents of this paper to disclose. Dr. Mehran has received research grant support from Eli Lilly, AstraZeneca, The Medicines Company, and BMS/Sanofi; has served as a scientific advisory board member for Abbott Laboratories, Boston Scientific Corporation, Covidien, Janssen Pharmaceuticals, The Medicines Company, and Sanofi; and has served as a consultant for AstraZeneca, Bayer, CSL Behring, Janssen Pharmaceuticals Inc., Merck & Co., Osprey Medical Inc., and Watermark Research Partners (modest).
- Received November 12, 2015.
- Revision received February 8, 2016.
- Accepted February 11, 2016.
- American College of Cardiology Foundation