Difference in Treatment Response Between Men and Women with Acute Myocardial Infarction with ST-segment Elevation Even When Following Well-established Protocols

The study “Comparison of Clinical and Epidemiological Profiles Between Men and Women with ST-Elevation Myocardial Infarction in Salvador from 2021 to 2023” provides an important contribution by demonstrating that, even in a setting supported by a well-structured ST-elevation myocardial infarction (STEMI) protocol, relevant differences in clinical profiles between men and women persist. Although treatment strategies were homogeneous between sexes—a noteworthy finding in a country where healthcare inequities are often the rule—the observation that women present later, are older at the time of the event, and more frequently receive potent antiplatelet agents reinforces the need to understand acute coronary syndrome in women according to their specific pathophysiological and clinical characteristics.¹

In recent years, increasing evidence has challenged the concept that myocardial infarction in women is simply “the same infarction, occurring later.” Contemporary data indicate that mechanisms such as coronary microvascular dysfunction, plaque erosion, and spontaneous coronary artery dissection are more prevalent among women, demanding greater diagnostic precision and tailored therapeutic strategies.^2,3 In parallel, atypical symptom presentation and lower perceived cardiovascular risk contribute to delays in seeking care—a phenomenon consistently observed worldwide, including in high-income countries.⁴

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