Advancing the understanding of acute coronary syndromes in women: insights from the GEDI-ACS registry
F Napoli, A Cascone, M Immobile Molaro, M B M Ancona, G Botti, M Sassi, L Anastasia, M Piccoli, D Trabattoni, L Barbieri, M Montorfano, G Esposito, E Agricola, A Franzone, A ChieffoAbstract
Background
Cardiovascular disease remains a leading cause of morbidity and mortality in women, yet important sex-related disparities persist in acute coronary syndromes(ACS). Women are frequently underdiagnosed and undertreated, experience higher short-term mortality and present with sex-specific or under-recognised risk factors complicating diagnosis and management. The Gender, Diversity and Inclusion GEDI-ACS registry is the first Italian prospective, multicentre study designed to identify the phenotypic and genetic profiles of women with ACS.
Purpose
To report preliminary findings from the first 93 women enrolled in the GEDI-ACS registry.
Methods
Women≥18 years admitted with ACS across Northern and Southern Italy were consecutively enrolled. Comprehensive clinical, imaging, biochemical and molecular phenotyping was performed, including genomics, transcriptomics, proteomics and metabolomics. Socioeconomic status, health literacy, quality of life and risk awareness were assessed through standardised questionnaires. All patients were treated according to current ESC guidelines1.
Results
Mean age was 66.1±12.1years, 97.8% were Caucasian and 94.6% Italian-born. Traditional cardiovascular risk factors were prevalent. From a female-specific perspective, most women(87.1%) were postmenopausal, with 13.9% reporting premature menopause; 30.1% had a history of miscarriage. In 81.7% ACS was the first manifestation of heart disease. Non-cardiac comorbidities were frequent, particularly vascular disorders(12.9%) and cancer(15.1%). Clinically, STEMI and NSTEMI predominated and MINOCA occurred in 38.7%, mainly Takotsubo syndrome and coronary spasm. Mean LVEF was 49.1±11.4. Psychosocial vulnerability was prominent: most women had low education (mean10.4±4.3years) and income, only 37.6% were employed and 41.9% had anxiety/depression. Health literacy was limited, with 69.8% reporting difficulty understanding health information and 70.9% requiring support during medical encounters. At 30 days no deaths, stroke or reinfarction were observed; 8.6% experienced recurrent symptom and therapy adherence was good.
Conclusions
The GEDI-ACS registry highlights the multidimensional profile of women with ACS, integrating clinical, biological and psychosocial domains. For many, ACS was the first cardiovascular event and frequently coexisted with non-cardiac comorbidities. Female-specific factors and adverse obstetric history support the need for tailored preventive strategies, while psychosocial and socioeconomic barriers, such as low income, anxiety and limited health literacy, may adversely affect recovery and adherence. The high prevalence of MINOCA underscores the importance of precise endotype characterisation through advanced cardiovascular imaging. Despite this complexity, short-term outcomes were favourable. Ongoing enrolment and multiomics integration will deepen the understanding of women’s cardiovascular risk and inform targeted management.GEDI ACS TableGEDI ACS Figure