Opinion statement
Despite recent efforts to reduce cardiovascular disease, it remains the leading cause of morbidity and mortality among women, particularly younger women. When compared to men, women have more inpatient complications, mortality, heart failure, and stroke following acute myocardial infarction (AMI) despite having less obstructive coronary artery disease. Moreover, women are less likely to have AMI from plaque rupture than men, and more likely to experience alternate etiologies of AMI including plaque erosion and spontaneous coronary artery dissection. Herein, we discuss current knowledge regarding women’s unique experience of AMI, including demographics, presentation, etiologies, and acute and outpatient care.
Similar content being viewed by others
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
•• Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN et al. Acute myocardial infarction in women. A scientific statement from the American Heart Association. Circulation. 2016;133(9):916–47. doi:10.1161/cir.0000000000000351. Key document highlighting the most updated and high yield information regarding acute myocardial infarction in women.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart disease and stroke statistics—2015 update. A report from the American Heart Association. Circulation. 2015;131(4):e29–e322. doi:10.1161/cir.0000000000000152.
Bucholz EM, Butala NM, Rathore SS, Dreyer RP, Lansky AJ, Krumholz HM. Sex differences in long-term mortality after myocardial infarction: a systematic review. Circulation. 2014;130(9):757–67. doi:10.1161/circulationaha.114.009480.
Berger JS, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW et al. Sex differences in mortality following acute coronary syndromes. JAMA. 2009;302(8):874–82. doi:10.1001/jama.2009.1227.
Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med. 1999;341(4):226–32. doi:10.1056/nejm199907223410402.
Lichtman JH, Leifheit-Limson EC, Watanabe E, Allen NB, Garavalia B, Garavalia LS, et al. Symptom recognition and healthcare experiences of young women with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2015;8(2 suppl 1):S31–S8. doi:10.1161/circoutcomes.114.001612.
DeVon HA, Ryan CJ, Ochs AL, Shapiro M. Symptoms across the continuum of acute coronary syndromes: differences between women and men. Am J Crit Care. 2008;17(1):14–24.
Arslanian-Engoren C, Patel A, Fang J, Armstrong D, Kline-Rogers E, Duvernoy CS, et al. Symptoms of men and women presenting with acute coronary syndromes. Am J Cardiol. 2006;98(9):1177–81. doi:10.1016/j.amjcard.2006.05.049.
Noureddine S, Arevian M, Adra M, Puzantian H. Response to signs and symptoms of acute coronary syndrome: differences between Lebanese men and women. Am J Crit Care. 2008;17(1):26–35.
Løvlien M, Schei B, Gjengedal E. Are there gender differences related to symptoms of acute myocardial infarction? A Norwegian perspective. Prog Cardiovasc Nurs. 2006;21(1):14–9. doi:10.1111/j.0197-3118.2006.04656.x.
Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813–22. doi:10.1001/jama.2012.199.
Ting HH, Bradley EH, Wang Y, et al. Factors associated with longer time from symptom onset to hospital presentation for patients with ST-elevation myocardial infarction. Arch Intern Med. 2008;168(9):959–68. doi:10.1001/archinte.168.9.959.
Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on Cardiovascular Nursing and Stroke Council. Circulation. 2006;114(2):168–82. doi:10.1161/circulationaha.106.176040.
O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;61(4):e78-e140. doi:10.1016/j.jacc.2012.11.019.
•• Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139–e228. doi:10.1016/j.jacc.2014.09.017. AHA/ACC Guidelines for management of Non-ST-elevation acute coronary syndromes.
Orencia A, Bailey K, Yawn BP, Kottke TE. Effect of gender on long-term outcome of angina pectoris and myocardial infarction/sudden unexpected death. JAMA. 1993;269(18):2392–7. doi:10.1001/jama.1993.03500180084039.
Wiviott SD, Cannon CP, Morrow DA, Murphy SA, Gibson CM, McCabe CH et al. Differential expression of cardiac biomarkers by gender in patients with unstable angina/non-ST-elevation myocardial infarction: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18) substudy. Circulation. 2004;109(5):580–6. doi:10.1161/01.cir.0000109491.66226.26.
Lu Y, Zhou S, Dreyer RP, Spatz ES, Geda M, Lorenze NP et al. Sex differences in inflammatory markers and health status among young adults with acute myocardial infarction: results from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) study. Circulation. 2017;10(2):e003470. doi:10.1161/circoutcomes.116.003470.
Shah ASV, Griffiths M, Lee KK, McAllister DA, Hunter AL, Ferry AV, et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ. 2015;350 doi:10.1136/bmj.g7873.
Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J. 2013;34(10):719–28. doi:10.1093/eurheartj/ehs411.
Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J. 1983;50(2):127–34. doi:10.1136/hrt.50.2.127.
Schwartz RS, Burke A, Farb A, Kaye D, Lesser JR, Henry TD, et al. Microemboli and microvascular obstruction in acute coronary thrombosis and sudden coronary death: relation to epicardial plaque histopathology. J Am Coll Cardiol. 2009;54(23):2167–73. doi:10.1016/j.jacc.2009.07.042.
Farb A, Burke AP, Tang AL, Liang Y, Mannan P, Smialek J et al. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation. 1996;93(7):1354–63. doi:10.1161/01.cir.93.7.1354.
Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47(8, Supplement):C13–C8. doi:10.1016/j.jacc.2005.10.065.
Reis SE, Holubkov R, Smith AJC, Kelsey SF, Sharaf BL, Reichek N, et al. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J. 2001;141(5):735–41. doi:10.1067/mhj.2001.114198.
Chokshi NP, Iqbal SN, Berger RL, Hochman JS, Feit F, Slater JN, et al. Sex and race are associated with the absence of epicardial coronary artery obstructive disease at angiography in patients with acute coronary syndromes. Clin Cardiol. 2010;33(8):495–501. doi:10.1002/clc.20794.
Gehrie ER, Reynolds HR, Chen AY, Neelon BH, Roe MT, Gibler WB, et al. Characterization and outcomes of women and men with non–ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Am Heart J. 2009;158(4):688–94. doi:10.1016/j.ahj.2009.08.004.
Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126(5):579–88. doi:10.1161/circulationaha.112.105718.
Nakashima T, Noguchi T, Haruta S, Yamamoto Y, Oshima S, Nakao K, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pectoris–Myocardial Infarction Multicenter Investigators in Japan. Int J Cardiol. 2016;207:341–8. doi:10.1016/j.ijcard.2016.01.188.
Saw J, Aymong E, Mancini GBJ, Sedlak T, Starovoytov A, Ricci D. Nonatherosclerotic coronary artery disease in young women. Can J Cardiol. 2014;30(7):814–9. doi:10.1016/j.cjca.2014.01.011.
Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A et al. Pregnancy-associated acute myocardial infarction. A review of contemporary experience in 150 cases between 2006 and 2011. Circulation. 2014;129(16):1695–702. doi:10.1161/circulationaha.113.002054.
Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7(5):645–55. doi:10.1161/circinterventions.114.001760.
Prasad M, Tweet MS, Hayes SN, Leng S, Liang JJ, Eleid MF, et al. Prevalence of extracoronary vascular abnormalities and fibromuscular dysplasia in patients with spontaneous coronary artery dissection. Am J Cardiol. 2015;115(12):1672–7. doi:10.1016/j.amjcard.2015.03.011.
Goel K, Tweet M, Olson TM, Maleszewski JJ, Gulati R, Hayes SN. Familial spontaneous coronary artery dissection: evidence for genetic susceptibility. JAMA Intern Med. 2015;175(5):821–6. doi:10.1001/jamainternmed.2014.8307.
Eleid MF, Guddeti RR, Tweet MS, Lerman A, Singh M, Best PJ et al. Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications. Circ Cardiovasc Interv. 2014;7(5):656–62. doi:10.1161/circinterventions.114.001676.
• Tweet MS, Eleid MF, Best PJM, Lennon RJ, Lerman A, Rihal CS et al. Spontaneous coronary artery dissection. revascularization versus conservative therapy. Circ Cardiovasc Interv. 2014;7(6):777–86. doi:10.1161/circinterventions.114.001659. Document guiding management decisions in women with AMI due to SCAD.
Nakayama N, Kaikita K, Fukunaga T, Matsuzawa Y, Sato K, Horio E et al. Clinical features and prognosis of patients with coronary spasm-induced non-ST-segment elevation acute coronary syndrome. J Am Heart Assoc. 2014;3(3). doi:10.1161/jaha.114.000795.
Ong P, Athanasiadis A, Hill S, Vogelsberg H, Voehringer M, Sechtem U. Coronary artery spasm as a frequent cause of acute coronary syndrome: the CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) study. J Am Coll Cardiol. 2008;52(7):523–7. doi:10.1016/j.jacc.2008.04.050.
Lanza GA, Careri G, Crea F. Mechanisms of coronary artery spasm. Circulation. 2011;124(16):1774–82. doi:10.1161/circulationaha.111.037283.
Cho SW, Park TK, Gwag HB, Lim AY, Oh MS, Lee DH et al. Clinical outcomes of vasospastic angina patients presenting with acute coronary syndrome. J Am Heart Assoc. 2016;5(11). doi:10.1161/jaha.116.004336.
Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373(10):929–38. doi:10.1056/NEJMoa1406761.
Chou AY, Sedlak T, Aymong E, Sheth T, Starovoytov A, Humphries KH, et al. Spontaneous coronary artery dissection misdiagnosed as Takotsubo cardiomyopathy: a case series. Can J Cardiol. 2015;31(8):1073.e5–8. doi:10.1016/j.cjca.2015.03.018.
Hakim FA, Kransdorf EP, Abudiab MM, Sweeney JP. Paradoxical coronary artery embolism—a rare cause of myocardial infarction. Heart Views Off J Gulf Heart Assoc. 2014;15(4):124–6. doi:10.4103/1995-705X.151089.
Kothawade K, Merz CNB. Microvascular coronary dysfunction in women—pathophysiology, diagnosis, and management. Curr Probl Cardiol. 2011;36(8):291–318. doi:10.1016/j.cpcardiol.2011.05.002.
Buchthal SD, den Hollander JA, Merz CNB, Rogers WJ, Pepine CJ, Reichek N, et al. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms. N Engl J Med. 2000;342(12):829–35. doi:10.1056/nejm200003233421201.
Mega JL, Morrow DA, Östör E, Dorobantu M, Qin J, Antman EM, et al. Outcomes and optimal antithrombotic therapy in women undergoing fibrinolysis for ST-elevation myocardial infarction. Circulation. 2007;115(22):2822–8. doi:10.1161/circulationaha.106.679548.
Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J. 2006;27(7):779–88. doi:10.1093/eurheartj/ehi810.
O’Donoghue M, Boden WE, Braunwald E, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 2008;300(1):71–80. doi:10.1001/jama.300.1.71.
Stefanini GG, Baber U, Windecker S, Morice M-C, Sartori S, Leon MB, et al. Safety and efficacy of drug-eluting stents in women: a patient-level pooled analysis of randomised trials. Lancet. 382(9908):1879–88. doi:10.1016/S0140-6736(13)61782-1.
Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, et al. Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) national quality improvement initiative. J Am Coll Cardiol. 2005;45(6):832–7. doi:10.1016/j.jacc.2004.11.055.
• Pandie S, Mehta SR, Cantor WJ, Cheema AN, Gao P, Madan M, et al. Radial versus femoral access for coronary angiography/intervention in women with acute coronary syndromes: insights from the RIVAL trial (Radial Vs femorAL access for coronary intervention). JACC Cardiovasc Interv. 2015;8(4):505–12. doi:10.1016/j.jcin.2014.11.017. Study which focuses on optimizing vascular access for women demonstrating the value of radial access.
Ahmed B, Dauerman HL. Women, bleeding, and coronary intervention. Circulation. 2013;127(5):641–9. doi:10.1161/circulationaha.112.108290.
Wasfy JH, Rosenfield K, Zelevinsky K, Sakhuja R, Lovett A, Spertus JA, et al. A prediction model to identify patients at high risk for 30-day readmission after percutaneous coronary intervention. Circ Cardiovasc Qual Outcomes. 2013;6(4):429–35. doi:10.1161/circoutcomes.111.000093.
Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM. Sex-based differences in early mortality after myocardial infarction. N Engl J Med. 1999;341(4):217–25. doi:10.1056/nejm199907223410401.
Bukkapatnam RN, Yeo KK, Li Z, Amsterdam EA. Operative mortality in women and men undergoing coronary artery bypass grafting (from the California Coronary Artery Bypass Grafting Outcomes Reporting Program). Am J Cardiol. 2010;105(3):339–42. doi:10.1016/j.amjcard.2009.09.035.
Vaccarino V, Abramson JL, Veledar E, Weintraub WS. Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women. Circulation. 2002;105(10):1176–81. doi:10.1161/hc1002.105133.
Herlitz J, Brandrup-Wognsen G, Karlson BW, Sjöland H, Karlsson T, Caidahl K, et al. Mortality, risk indicators of death, mode of death and symptoms of angina pectoris during 5 years after coronary artery bypass grafting in men and women. J Intern Med. 2000;247(4):500–6. doi:10.1046/j.1365-2796.2000.00645.x.
Petro K, Dullum M, Garcia J, Pfister A, Qazi AG, Boyce S, et al. Minimally invasive coronary revascularization in women: a safe approach for a high-risk group. Heart Surg Forum. 2000;3(1):41–6.
Gurudevan SV, Nelson MD, Rader F, Tang X, Lewis J, Johannes J et al. Cocaine-induced vasoconstriction in the human coronary microcirculation: new evidence from myocardial contrast echocardiography. Circulation. 2013;128(6):598–604. doi:10.1161/circulationaha.113.002937.
Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary spasm. Circulation. 1993;87(1):76–9. doi:10.1161/01.cir.87.1.76.
Njølstad I, Arnesen E, Lund-Larsen PG. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction. a 12-year follow-up of the Finnmark study. Circulation. 1996;93(3):450–6. doi:10.1161/01.cir.93.3.450.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38-e360. doi:10.1161/cir.0000000000000350.
Kawachi I, Colditz GA, Stampfer MJ, et al. Smoking cessation in relation to total mortality rates in women: a prospective cohort study. Ann Intern Med. 1993;119(10):992–1000. doi:10.7326/0003-4819-119-10-199311150-00005.
Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 364(9438):937–52. doi:10.1016/S0140-6736(04)17018-9.
van der Giezen A, Schopman-Geurts van Kessel J, Schouten E, Slotboom B, Kok F, Collette H. Systolic blood pressure and cardiovascular mortality among 13,740 Dutch women. Prev Med. 1990;19(4):456–65.
Stone NJ, Robinson J, Lichtenstein AH, Merz CNB, Blum CB, Eckel RH et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013. doi:10.1161/01.cir.0000437738.63853.7a.
Ishii M, Kaikita K, Sato K, Yamanaga K, Miyazaki T, Akasaka T et al. Impact of statin therapy on clinical outcome in patients with coronary spasm. J Am Heart Assoc 2016;5(5). doi:10.1161/jaha.116.003426.
Kalyani RR, Lazo M, Ouyang P, Turkbey E, Chevalier K, Brancati F, et al. Sex differences in diabetes and risk of incident coronary artery disease in healthy young and middle-aged adults. Diabetes Care. 2014;37(3):830–8. doi:10.2337/dc13-1755.
Kanaya AM, Grady D, Barrett-Connor E. Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. Arch Intern Med. 2002;162(15):1737–45. doi:10.1001/archinte.162.15.1737.
Azimova K, Juan ZS, Mukherjee D. Cardiovascular safety profile of currently available diabetic drugs. Ochsner J. 2014;14(4):616–32.
Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004;66(6):802–13.
Whang W, Kubzansky LD, Kawachi I, Rexrode KM, Kroenke CH, Glynn RJ, et al. Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses’ Health Study. J Am Coll Cardiol. 2009;53(11):950–8. doi:10.1016/j.jacc.2008.10.060.
Smolderen KG, Strait KM, Dreyer RP, D’Onofrio G, Zhou S, Lichtman JH et al. Depressive symptoms in younger women and men with acute myocardial infarction: insights from the VIRGO study. J Am Heart Assoc 2015;4(4). doi:10.1161/jaha.114.001424.
Liang JJ, Tweet MS, Hayes SE, Gulati R, Hayes SN. Prevalence and predictors of depression and anxiety among survivors of myocardial infarction due to spontaneous coronary artery dissection. J Cardiopulm Rehabil Prev. 2014;34(2):138–42. doi:10.1097/HCR.0000000000000030.
AHA Science Advisory. Progress in cardiovascular nursing. 2009;24(1):19–26. doi:10.1111/j.1751-7117.2009.00028.x.
Glassman AH, Bigger J Jr, Gaffney M. Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression: seven-year follow-up of SADHART participants. Arch Gen Psychiatry. 2009;66(9):1022–9. doi:10.1001/archgenpsychiatry.2009.121.
Lespérance F, Frasure-Smith N, Koszycki D, et al. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA. 2007;297(4):367–79. doi:10.1001/jama.297.4.367.
Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents∗. Am J Med. 2000;108(1):2–8. doi:10.1016/S0002-9343(99)00301-0.
Balady GJ, Ades PA, Bittner VA, Franklin BA, Gordon NF, Thomas RJ et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. 2011;124(25):2951–60. doi:10.1161/CIR.0b013e31823b21e2.
Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation. 2011;123(21):2344–52. doi:10.1161/circulationaha.110.983536.
Dunlay SM, Pack QR, Thomas RJ, Killian JM, Roger VL. Participation in cardiac rehabilitation, readmissions and death after acute myocardial infarction. Am J Med. 2014;127(6):538–46. doi:10.1016/j.amjmed.2014.02.008.
Krittanawong C, Tweet MS, Hayes SE, Bowman MJ, Gulati R, Squires RW, et al. Usefulness of cardiac rehabilitation after spontaneous coronary artery dissection. Am J Cardiol. 2016;117(10):1604–9. doi:10.1016/j.amjcard.2016.02.034.
Chou AY, Prakash R, Rajala J, Birnie T, Isserow S, Taylor CM, et al. The first dedicated cardiac rehabilitation program for patients with spontaneous coronary artery dissection: description and initial results. Can J Cardiol. 2016;32(4):554–60. doi:10.1016/j.cjca.2016.01.009.
Rossouw JE, Manson JE, Kaunitz AM, Anderson GL. Lessons learned from the Women’s Health Initiative trials of menopausal hormone therapy. Obstet Gynecol. 2013;121(1):172–6.
Tweet MS, Gulati R, Hayes SN. What clinicians should know about spontaneous coronary artery dissection. Mayo Clin Proc. 2015;90(8):1125–30. doi:10.1016/j.mayocp.2015.05.010.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Women’s Health
Rights and permissions
About this article
Cite this article
Tweet, M.S., Best, P. & Hayes, S.N. Unique Presentations and Etiologies of Myocardial Infarction in Women. Curr Treat Options Cardio Med 19, 66 (2017). https://doi.org/10.1007/s11936-017-0571-1
Published:
DOI: https://doi.org/10.1007/s11936-017-0571-1