Results:

A total of 82,196 were included in the study, of which 21,071 (25.6%) were women. Women with ACS were older than men (69.0 vs. 61.1 years, p < 0.001) and had more comorbidities. Men were more likely to present with ST-segment elevation myocardial infarction (STEMI), a smoking history, and a history of heart disease. Women were more likely to present with heart failure (9.1% vs. 5.7%, p < 0.001) and cardiogenic shock (3.1% vs. 2.8%, p = 0.004). Women were also more likely to have longer times from symptom onset to hospital presentation than men. After multivariable adjustment, eligible women were less likely to receive early dual antiplatelet therapy (DAPT), heparins during hospitalization, and reperfusion therapy for STEMI as compared to men. With respect to strategies for secondary prevention, eligible women were less likely to receive DAPT, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, statins at discharge, and smoking cessation and cardiac rehabilitation counseling during hospitalization. In-hospital mortality rate was higher in women than in men (2.60% vs. 1.50%, p < 0.001). However, after adjustment for clinical characteristics and treatments, there was no significant difference in in-hospital mortality between men and women for STEMI (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.00–1.41) or NSTEMI (OR, 0.84; 95% CI, 0.66–1.06).