A marked reduction in sex-related disparities in percutaneous coronary intervention use among patients with myocardial infarction in Switzerland from 2007 to 2024 was observed, offering hope that 'the long shadow of the Yentl syndrome finally may be receding.'
Key Findings
Results
Men were more likely than women to undergo percutaneous coronary intervention (PCI) for both STEMI and non-STEMI across all three 6-year study periods.
The sex difference in PCI use was statistically significant across all periods (P<0.001) for both STEMI and non-STEMI.
The study enrolled 48,357 patients total between January 2007 and December 2024.
Men comprised 74.8% of the cohort (36,169 patients) and women 25.2% (12,188 patients).
STEMI accounted for 57.6% of the population and non-STEMI for 42.4%.
Results
The sex gap in PCI use for STEMI narrowed significantly over the three consecutive 6-year periods.
The sex gap in STEMI PCI use was 8.8% (95% CI, 8.0%–9.6%) in 2007–2012.
The gap decreased to 3.2% (95% CI, 2.7%–3.9%) in 2013–2018.
The gap further decreased to 2.7% (95% CI, 2.0%–3.5%) in 2019–2024.
This represents a reduction of approximately 69% in the sex gap for STEMI over the full study period.
Results
The sex gap in PCI use for non-STEMI also narrowed substantially over the three consecutive 6-year periods.
The sex gap in non-STEMI PCI use was 14.8% (95% CI, 13.8%–16.0%) in 2007–2012.
The gap decreased to 6.3% (95% CI, 5.4%–7.2%) in 2013–2018.
The gap was 7.4% (95% CI, 6.2%–8.7%) in 2019–2024, representing a slight increase from the middle period.
Despite a slight uptick in the final period, the overall reduction from 2007–2012 to 2019–2024 was approximately 50%.
Methods
The study used the Swiss nationwide AMIS Plus registry, a prospective registry covering 84 hospitals over 18 years.
AMIS Plus stands for Acute Myocardial Infarction in Switzerland and is a nationwide prospective registry.
The registry includes patients with acute myocardial infarction admitted to 84 Swiss hospitals.
The study period spanned January 2007 to December 2024, divided into three consecutive 6-year periods.
The clinical trial registry identifier is NCT01305785.
Conclusions
The Yentl syndrome, referring to sex-based disparities in acute myocardial infarction management, may be receding based on these temporal trend data.
The term 'Yentl syndrome' was coined by Bernadine Healy in 1991 to describe disparities in the management of acute myocardial infarction between men and women.
The authors conclude these findings 'offer hope that the long shadow of the Yentl syndrome finally may be receding.'
Despite the narrowing, a statistically significant sex gap in PCI use persisted through the most recent period (2019–2024) for both STEMI and non-STEMI.
What This Means
This research suggests that a longstanding gap in heart attack treatment between men and women in Switzerland has been shrinking over the past two decades. Using data from a large national registry of over 48,000 heart attack patients treated at 84 hospitals between 2007 and 2024, researchers found that women have historically been less likely than men to receive a procedure called percutaneous coronary intervention (PCI), commonly known as a stent procedure or angioplasty, which opens blocked arteries. This disparity — known as the 'Yentl syndrome' — has been a recognized problem in cardiology since at least 1991.
The study found that for the most severe type of heart attack (STEMI), the treatment gap between men and women shrank from about 8.8 percentage points in 2007–2012 down to 2.7 percentage points by 2019–2024. For less severe heart attacks (non-STEMI), the gap fell from nearly 15 percentage points to about 7 percentage points over the same timeframe. While a gap still exists in the most recent period, the trend is clearly moving toward more equal treatment.
This research matters because receiving timely and appropriate treatment for a heart attack is critical to survival and recovery. The fact that women were less likely to receive this key intervention raised serious concerns about equity in cardiac care. These findings suggest that awareness campaigns, updated clinical guidelines, and changes in medical practice over the past two decades may be helping to close this gap, though the persistence of some disparity indicates there is still room for improvement.
Schoenenberger-Berzins R, Messerli F, Schoenenberger A, Foster-Witassek F, Rickli H, Pedrazzini G, et al.. (2026). Management of Acute Coronary Syndromes: Is the Yentl Syndrome Vanishing?. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.049890