Women with acute coronary syndromes who present for percutaneous revascularization have clinical characteristics that place them at higher risk for adverse events. These women are older with an increased incidence of hypertension, diabetes, and congestive heart failure. At angiography, women with epicardial coronary disease tend to have smaller diameter vessels, which predict an increase in procedural complications. Recent observations suggest that in the new device era, women with unstable angina/non-Q myocardial infarction may have clinical outcomes similar to their male counterparts; however, women who present with acute ST-elevation myocardial infarction and undergo catheter-based revascularization procedures remain at increased risk for adverse events. Although adjunctive glycoprotein IIb/IIIa antagonists may improve procedural outcomes, women undergoing catheter-based revascularization procedures are at increased risk for hemorrhagic complications. Despite these high-risk features, catheter-based reperfusion therapies remain an effective treatment strategy in women with acute coronary syndromes.