Differences in symptoms of Acute Coronary Syndromes (ACS) according to gender are documented. There is no recent data from population-based registries in France.

To compare clinical presentation of ACS between genders in hospitalized patients.

We analyzed data from the French MONICA registries on 11,556 patients aged 35–74 and hospitalized for a first ACS between 2011 and 2015.

Precordial pain was more frequent in men (86.0% vs. 80.7% P<10⁻⁴), whereas more women reported non-precordial pain (6.0% vs. 4.7% P<10⁻³) and no pain (13.3% vs. 9.2% P<10⁻⁴). Dyspnea, malaise or severe symptoms (acute pulmonary edema, shock, cardiac arrest) were more frequent in women than in men (25.4% vs. 17.9% P<10⁻⁴, 19.6% vs. 14.2% P<10⁻⁴ and 16.0% vs. 12.4% P<10⁻⁴, respectively). With age, in both genders, proportions of precordial pain decreased whereas those of no pain, severe symptoms and dyspnea increased (Table 1). Only for malaise the sex difference was significant in all groups. In women aged 35–44 and 45–54, the proportion of severe symptoms was not significantly higher as compared with men of the same age. Difference between genders for dyspnea was significant for all patients except for those aged 45–54. In patients aged 35–44, no significant differences were observed for pain.

Except for malaise, differences of symptoms between genders were affected by age. Age and sex-specific characteristics of ACS may partially explain these results.