Background Many studies have examined gender related differences in the presenting symptoms, management and prognosis of patients with acute coronary syndrome (ACS). Much data are available from industrialized countries, in which ACS is a major cause of morbidity and mortality, but relatively little information has been obtained from China,where an epidemic of cardiovascular disease is starting to emerge. The purpose of this study was to assess the differences in clinical practice in a national Chinese sample.Methods A total of 12 medical teaching hospitals participated in CRACE. Data collection began in 2001 and continued until 2004, 1301 patients with ACS were enrolled into the study. We compared the clinical demographics, different therapies and outcomes in hospitals between female and male patients with ACS.Results Patients had an average age of 63.13 years (ranging from 27 to 93 years) and 318 female and 983 male subjects were enrolled. Female subjects were older than male patients (67.23 years vs 61.80 years, P＜0.0001). The incidence of angina, heart failure, diabetes mellitus and hypertension in the female group was higher than in male group(73.6% vs 62.3%, P＜0.0001; 8.2% vs 5.7%, P=0.031; 30.8% vs 18.6%, P＜0.0001 and 66.4% vs 56.8%, P=0.001 respectively), but the incidence of smoking was less in the female group than in the male group (6.6% vs 66.2%,P＜0.0001). More male patients presented with ST-segment elevation myocardial infarction (STEMI) compared with female patients (48.5% vs 39%, P=0.002). With the exception of β-blocker administration, no differences were found among medications including aspirin, ACEI, lipid lowering agents and low-molecular-weight heparin (LMWH) between female and male patients presenting with ACS in hospitals. Compared with male patients with non-ST-segment elevation(NSTE) ACS, female subjects were more prone to receive β-blockers (75.1% vs 63.4%, P=0.001). Among STEMI and NSTE-ACS patients, fewer female subjects received reperfusion therapy compared with male subjects (37.1% vs 26.8%,P=0.013 for STEMI; 53.6% vs 37.2 %, P＜0.0001 for NSTE-ACS). Recurrent angina was more often seen in the female group of patients with the whole spectrum of ACS (25% vs 14.5%, P=0.005 for STEMI; 29.4% vs 20.2%, P=0.001 for NSTE-ACS) as was true for patients with congestive heart failure. There was no significant difference in in-hospital death rates between the two groups with ACS (5.6% vs 7.1%, P=0.2 for STEMI, and 2.1% vs 1.4%, P=0.738 for NSTE-ACS).Conclusions Female patients with ACS were older than male subjects and thus more often had concomitant diseases but less often had a history of smoking. They less often received reperfusion therapies and more often had higher in-hospital recurrent angina. However, there was no significant difference in in-hospital mortality between the female and male patients.