OBJECTIVE: The need for treatment of cardiac disease in women can go unrecognised and access to appropriate health care can be limited. We evaluated the effect of gender on changes in long-term health-related quality of life (HRQoL) after coronary stent implantation (CSI) in conventional treatment of coronary artery disease (CAD). METHOD: In this prospective comparative multi-centre cohort study in Germany, patients with CAD undergoing coronary angioplasty were electively treated with stents. Standardised questionnaires were completed by patients at baseline, 3, 6, 12, and 18 months following angioplasty and documented patient health-related (SF-36) and disease-specific (MacNew heart disease questionnaire) quality of life, as well as clinical outcomes. RESULTS: From April until August 2004, 103 women (16%, mean age 66,b11) und 546 men (mean age 64,b10) were treated with CSI. There were no significant differences in socio-demographic factors, cardiovascular risk factors and severity of CAD. At baseline, all aspects of HRQoL evaluated by SF-36 and MacNew were significantly poorer in women than in men (p=0.004). Three months following stent implantation, the difference in improvement in the SF-36 aspects of general health (p=0.005), role emotional (p=0.034) and the mental summary score (p=0.027) was significantly greater in women than in men, although their actual HRQoL remained significantly lower in most aspects. After 6 months, the difference in improvement in women was significantly greater to baseline in the aspect of role emotional than men (p=0.019). Gender differences in improvement were not demonstrated in the follow-up MacNew questionnaires. CONCLUSIONS: In comparison to men, baseline HRQoL in women may be lower before receiving CSI treatment. However, three and six months following implantation of a coronary stent, the difference in improvement in many aspects of HRQoL was greater in women than in men. Women may have a wider range of potential improvement after coronary stent implantation than men.