Scope: The influence of patient gender on the management of non-ST elevation acute coronary syndromes (NSTE-ACS) in Romania is unknown.

Methods: The data of 1,418 consecutively enrolled patients in the National Romanian NSTE-ACS Regis-try in 9 invasive hospitals between 2016 and 2019 was analysed.

Results: 995 patients were male (70%) and 423 fe-male (30%). Female patients were older (62.6 vs. 67.3 years, p<0.001). No differences between genders were found regarding symptom onset to hospital time, type of symptoms and type of NSTE-ACS. Peripheral ar-tery disease (p<0.001), prior percutaneous coronary intervention (PCI) (p<0.05), coronary artery bypass grafting (CABG) (p<0.01) and an active/former smo-king status (p<0.001) were more frequent in men. An-terior ACS (p<0.001), a lower admission haemoglobin (12.9 vs 14.1, p<0.001), lower eGFR (65.74 vs 76.52, p<0.001), and a higher in-hospital GRACE score (mean 137.51 vs 127.76, p<0.001) were found in the female group. Women were more likely to receive clopidogrel (p<0.001) in-hospital, while men ticagrelor (p<0.001). No other differences in the in-hospital medical thera-py were found. The time from admission to coronary angiogram (median 1325 minutes – men, median 1440 minutes – women, p 0.149) and radial access usage (61.2%) were similar between genders. Non-obstruc-tive coronary artery disease (CAD) was more often found in women (18.2% vs 7.2%, p<0.001), especially in the UA subgroup (27.2%). Ad-hoc PCI was perfor-med in 92.8% of cases in which PCI was indicated. No significant differences were found between genders re-garding PCI characteristics. The reported CABG rate in the same hospital stay was reported at 4.69%. No differences were observed between the mean durati-on of hospital stay and in-hospital mortality (1.41%). Globally, at discharge, men received aspirin, dual antiplatelet therapy and ticagrelor more frequently that women (p<0.001). The antiplatelet treatment strategies were similar for patients below the age of 65. The type of treatment with other drugs was similar.

Conclusions: This data confirmed the older age of women with NSTE-ACS and the higher atherosclerotic burden in men. The management of NSTE-ACS in Ro-mania is not gender-biased, with regards to access to optimal management in invasive hospitals. The higher rate of non-obstructive CAD and older age of NSTE-ACS in women possibly explains the differences in an-tiplatelet strategies between genders. PCI is the main type of treatment for NSTE-ACS, the very high ad-hoc PCI rate, even in 2 or 3 vessel disease, being probably related to the low access to CABG in Romania. The authors were supported by the Romanian Academy of Medical Sciences and European Regional Development Fund: Funding Contract 2/Axa 1/31.07.2017/SMIS 107124.