Psychological distress (i.e., symptoms of depression, anxiety, posttraumatic stress disorder, chronic or acute stress, and negative emotions) is both a risk factor for acute coronary syndrome (ACS) and a common consequence of ACS, with important sex differences. Compared with men, women experience a disproportionate burden of psychological distress before and after ACS. Women with ACS also have longer treatment delays, receive fewer invasive interventions, and have higher mortality rates. Screening for psychological distress in patients with ACS may help identify those at increased risk for complications.