Why are women with ST-elevation myocardial infarction treated differently to men?

STEMI and coronary artery disease are major but underappreciated killers of Australian women

This issue of the Journal includes confronting data about inequities in the treatment and outcomes for men and women with ST-elevation myocardial infarction (STEMI).1 Khan and colleagues report that the 6-month mortality for women presenting with STEMI is twice that of men, a difference that persists after statistical correction for age and comorbid conditions. The article relates worrying evidence of a disparity in the delivery of evidence-based treatment, raising many important questions: What barriers are preventing women from presenting for treatment earlier? Why are there delays in providing women with recognised life-saving treatments? Why are women as a group treated less intensively than men despite having higher Global Registry of Acute Coronary Events (GRACE) risk scores? What biological differences require distinct therapeutic approaches and dedicated clinical trials?