Background <p>For the management of acute coronary syndrome, literature shows lower healthcare providers’ guideline adherence for women than for men. Since less is known about the management of chronic coronary syndrome (CCS), this study investigated patient-related sex differences in providers’ guideline adherence for invasive coronary angiography (CA) performed in patients with suspected CCS.</p> Methods <p>Using data from the German ENLIGHT-KHK trial, patients with suspected CCS who underwent a CA were analysed. To assess the association between patient sex and physicians’ adherence to the German National Disease Management Guideline “Chronic coronary artery disease” of 2019, binary logistic regression models were developed. Covariates included age, symptoms, risk factors, comorbidities, and non-invasive testing and its results. To examine sex differences in predictors of guideline adherence, models were run separately for women and men.</p> Results <p>Two hundred seventy-three women and three hundred eighty-six men were included (aged 67 ± 10&#xa0;years). Physicians’ guideline adherence for CA was lower for women than for men (19.4% vs. 30.1%, <i>p</i> = 0.002). CAs were less likely to be guideline-adherent for women with suspected CCS than men (OR 0.4, <i>p</i> &lt; 0.05). Guideline adherence predictors differed between women and men. For example, men’s predictors included non-invasive testing and its results, age, typical angina and smoking; of these, only a positive non-invasive test result had an impact for women.</p> Conclusion <p>Our results indicate a less guideline-adherent diagnostic workup of CA for women with suspected CCS than men. This might reflect a limited awareness of CCS in women and insufficiently sex-specific guideline recommendations.</p> Trial registration <p>German Clinical Trials Register DRKS00015638, Registered February 19, 2019; Universal Trial Number (UTN): U1111-1227-8055.</p> Graphical abstract <p></p>