CT Background: Myocardial infarction (MI) and cardiovascular disease were long believed to be exclusively male conditions. Thankfully, there is growing recognition in both the medical literature and the public that heart disease is the leading cause of mortality for women and that cardiovascular illness is gender insensitive. This study aimed to compare MACE among post-menopausal females admitted to CCU with acute coronary syndromes. Methods: The current study included 144 female patients with mean age 59.32 years. Mean BMI was 26.85 kg/m2, and positive family history was 78.5%. As regards comorbidity, 41.7%, 48.6%, and 41.7% had comorbid diabetes, hypertension, and dyslipidemia. STEMI was 55.6% of patients in which 10 cases received thrombolytic therapy and 70 cases admitted to PCI. NSTEMI and unstable angina patients were 44.4% in which 20 cases were admitted for PCI and 44 cases received medical treatment. Results: we enrolled 144 post-menopausal patients presented with acute coronary syndromes and in comparison between the conservative and invasive methods of treatment in each group of STEMI and NSTEMI and following-up the patients for one month for MACE, the MACE was higher in group of invasive arm than conservative arm with 37.8% versus 18.5 % respectively, Heart failure was 7.4% versus 21.1%, Serious arrhythmia was 14.8% versus 26.7%, Reinfarction was 6.7% versus 3.7%,Mortality was 6% versus 0%. Conclusion: According to the findings of our research, it is possible to conclude, "Compared to the non-invasive approach, the invasive option is associated with worse outcomes in patients with NSTEMI. The non- invasive strategy is associated with better outcomes than the invasive option. Keywords: Myocardial infarction; Acute coronary syndrome; Major cardiac events; Postmenopausal females