Numerous re- ports14,315,1131,1132 and an expert consensus statement175 have examined the diagnostic accuracy of the exercise ECG and various imaging modalities in large cohorts of women. Overall, most reports document an improvement in diagnostic accuracy with imaging when compared to a standard exercise ECG,175 although that improvement does not necessarily translate into improved clinical outcomes.147 From a meta- analysis, the diagnostic sensitivity and specificity were 72% and 88% for women undergoing dobutamine stress echocar- diography.149 From a small controlled clinical trial, diagnostic specificity was improved considerably when using gated Tc-99m myocardial perfusion SPECT over Tl-201 myocar- dial perfusion SPECT (92% versus 67%) because of im- proved image quality.1133 Overall, sensitivity and specificity of myocardial perfusion SPECT were reported as 88% and 96% for women.86,175,1134 For CMR, one study reported a diagnostic sensitivity and specificity of 92% and 80% with vasodilator stress magnetic resonance myocardial In part related to differing pathophysiology and clinical presentation, substantial differences in provision of clinical care have been observed between men and women with CAD.1135 Despite increasing recognition of the risks of worsening IHD and attendant complications in women, the frequency with which they are prescribed important risk- modifying therapies such as statins, aspirin, and beta blockers after episodes of ACS remains significantly lower than among men.1136,1137 Among patients with documented SIHD, however, the differences between men and women appear to be much smaller with regard to prescription of these Data from COURAGE suggest that the benefits of GDMT alone in comparison with GDMT plus PCI were similar for men and women.366,1138 Moreover, the outcomes of revascu- larization appear to be less favorable among women than men,1139 1142 although very few women were enrolled in COURAGE. 