I shall use a picture to illustrate this.
This is a reference card. Nothing special about it comes with a blower design which blows the air out of the case. Normally good in cases that do not have a good amount of airflow flowing within there case.
This is a aftermarket cooler. This is a card comes with quieter fans and runs cooler as well. However, this video card will push air into your case and rely on the rest of your cases cooling to get the most out of the card. However that being said these are the stronger of the two cards giving the cooling and components that are used with the cards caps, chokes, and mosfets.