Cardiovascular disease remains the leading cause of death among women nowadays. However, there is a persistent lack of awareness of the impact of different risk factors on women's cardiovascular health, in specific pregnancy-related complications, hormonal changes, and psychological aspects. Moreover, there is still not enough awareness of the importance of coronary artery disease (CAD) in women, which leads to a delay in the diagnosis and prompt treatment, particularly during emergent coronary scenarios. Although guidelines suggest the same treatment for women and men who present with acute coronary syndrome (ACS), women are still undertreated. Contemporary data show an improvement over time in the management of ACS in women, however, women are still less likely than men to receive revascularization and pharmacological treatments. Women have higher rates of complications and mortality, in particular the young population, in which all outcomes are still worse in women compared to men. In this review, we aim to emphasize the importance of women's risk factors, women-specific pathophysiology, and clinical presentation in the setting of ACS. This is a review of current challenges in the diagnosis and treatment of women with ACS.

Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: We retrospectively analyzed consecutive patients referred to a tertiary center for evaluation of dMR of greater than moderate degree, who had normal sinus rhythm, had a left ventricular ejection fraction of above 60%, and did not suffer from any other major valvular disorders. The primary outcome was the combined rate of all-cause mortality, mitral intervention, or new-onset atrial fibrillation (AF) at 5 years following index echocardiogram. Secondary outcomes included individual components of the primary outcome. Results: Overall, 135 patients (median age 68 (IQR, 58–74) years; 93 (68.9%) males; 89 (65.9%) with severe MR) met the inclusion criteria and were followed for 115.2 (IQR, 60.0–155.0) months. Patients with a reversed PV flow pattern (PVFP) (n = 34) more often presented with severe MR compared to those with a normal (n = 49) and non-reversed PVFP (n = 101) (RR = 2.03 and 1.59, respectively, all p < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, p = 0.008 and 0.018, respectively). Furthermore, a reversed PVFP was independently associated with a higher risk of the primary outcome compared to normal PVFP (HR 2.53, 95% CI 1.21–5.31, p = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, p = 0.022). Conclusion: PV flow reversal is associated with a worse 5-year composite of mortality, mitral intervention, or AF in patients with significant dMR.