Patients presenting with acute coronary syndromes disclose a number of gender-related differences. Women are more likely than men to have unstable angina and less likely to present with myocardial infarction. Women have a better prognosis than men among patients with unstable angina. Among patients with myocardial infarction without ST-segment elevation, men and women show similar outcomes. In contrast, among patients with myocardial infarction and ST-segment elevation, women consistently show a worse prognosis than men. This difference is not fully explained by age, comorbidities, extent of epicardial artery disease, or baseline left ventricular function, and may reflect gender differences in pathophysiological, functional and anatomical variables. Moreover, revascularization procedures and several anti-ischemic drugs appear underutilized in women.