Preliminary results from an Italian registry describe the risk profile of women experiencing acute coronary syndromes and provide insights to improve management.1 These findings were presented today at the EAPCI Summit 2026, a new event organised by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), an association of the European Society of Cardiology (ESC).
Ischaemic heart disease is a common condition in which the coronary arteries become narrowed due to the build-up of fatty material. Acute manifestations of ischaemic heart disease – called acute coronary syndromes (ACS) – include angina and heart attacks (myocardial infarction [MI]).
ACS shows important differences between men and women. Evidence suggests that although fewer women develop ACS than men, women are at greater risk of dying than men in the same age group.2
As explained by Doctor Francesca Napoli from IRCCS San Raffaele Scientific Institute, Milan, Italy, more needs to be done to understand ACS and its effective treatment in women: "There is underrepresentation of women with ACS in clinical trials, despite cardiovascular disease being a leading cause of mortality." She continued: "The Gender, Diversity and Inclusion–Acute Coronary Syndromes (GEDI–ACS) registry is the first multicentre, prospective Italian registry dedicated to studying ACS in women. We aim to integrate clinical, sex-specific, socioeconomic, psychosocial, biochemical and molecular data to capture a multidimensional perspective and ultimately advance more accurate diagnosis, equitable management and improved outcomes for women with ACS."
The study is enrolling 100 consecutive women presenting with ACS (ST-segment elevation MI [STEMI], non-ST-segment elevation MI [NSTEMI]) or unstable angina) across multiple centres in Northern and Southern Italy: IRCCS San Raffaele Scientific Institute (Milan), AOU Federico II Naples (Naples), Centro Cardiologico Monzino (Milan) and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Milan), ensuring the inclusion of patients from different geographic, socioeconomic and cultural backgrounds.
Clinical data from the first 68 patients were presented at the EAPCI Summit. The median age of the study population was 68 years and 7.4% were non-Caucasian. Most women (85.3%) had low health literacy.
Cardiovascular risk factors were frequently observed: 83.6% had dyslipidaemia, 77.9% had hypertension and 50.0% had a history of smoking. In total, 32.3% reported miscarriage and 16.2% reported premature menopause. Autoimmune diseases were present in 32.2% of patients, while 16.2% had a history of cancer and almost half (42.6%) experienced anxiety/depression.
For most patients, ACS (86.0%) was the first manifestation of cardiovascular disease, with chest pain (88.2%) the main symptom. The type of ACS was STEMI in 38.2% of women, NSTEMI in 36.8% and unstable angina in 25.0%. Over one-third (38.2%) had MI with non-obstructive coronary arteries (MINOCA), a condition that occurs when patients have a heart attack without evidence of major blockages to the coronary arteries.
Outcomes were favourable – no deaths, strokes or reinfarctions occurred during the first 30 days. Recurrent chest pain was experienced by 11.3% of patients.
Doctor Napoli discussed the implications: "ACS often represented the first cardiovascular event. The common coexistence of ACS with noncardiac comorbidities, miscarriage and premature menopause provide insights into how we may be able to tailor preventive approaches. MINOCA was also a frequent finding and yet the best way to treat it is still unknown. The high levels of anxiety/depression and poor health literacy we found are important considerations as we try to support women with ACS more effectively to enhance recovery."
Professor Alaide Chieffo , Principal Investigator of the GEDI-ACS registry, EAPCI President and EAPCI Summit 2026 Programme Co-Chair concluded: "The registry will continue with additional enrolment and follow-up. We will also combine clinical findings with genetic and molecular data to deepen our understanding of disease mechanisms and contribute to more precise and inclusive approaches to ACS care in women."
