Although women who sustain coronary events (myocardial infarction, coronary bypass graft surgery, or percutaneous transluminal coronary angioplasty) have less favorable outcomes than do their male counterparts, the optimal approach to the evaluation of women with chest pain has not yet been ascertained. There is substantial documentation of the lesser use of invasive diagnostic and therapeutic interventions for women than for men, despite symptoms of comparable or greater severity among women. This report reviews the information available to guide the selection of noninvasive test procedures for women with chest pain syndromes, highlighting clinical variables, particularly the characteristics of the chest pain and the coronary risk profile. Because coronary arteriography appears to be a major determinant of access to myocardial revascularization procedures, the less aggressive diagnostic evaluation of women with chest pain in general, and of those with abnormal noninvasive test results in particular, remains of concern. The role of gender differences in diagnostic testing in determining the worse prognosis of clinically manifest coronary disease in women has yet to be delineated.