Sex differences in electrocardiographic patterns among patients with acute coronary syndromes

Abstract

Sex-based differences in ACS presentation and outcomes have been observed, but limited information is available on sex-specific electrocardiogram (ECG) features and their prevalence in this context. The aim of this study was to compare the prevalence of different ECG patterns between sexes and their prognostic roles for in-hospital mortality in ACS patients. This prospective single-center study (NCT02438085)° was conducted from June 2018 to December 2019, including 841 consecutive patients. Data on baseline characteristics, ECG findings, treatments, and outcomes were collected. Statistical analyses were performed to determine differences in the prevalence of various ECG patterns and identify independent predictors of in-hospital mortality. Males more frequently presented with ST-segment elevation (51% vs. 43%, p  = 0.031) and hyperacute T waves (13% vs. 7%, p  = 0.006) than females. Moreover, females more often had a normal ECG at admission (15% vs. 9%, p  = 0.01). In female STEMI negative T waves (50% vs. 38%, p  = 0.025) were more common than in males. Hyperacute T waves were linked to a higher risk of in-hospital death in female STEMI cases (OR=6.25, 95% CI: 1.0 −39.7, p  = 0.048). Additionally the development of left bundle branch block during hospitalization (OR=14.4, 95% CI: 1.48–14 p  = 0.02) was a significant predictor of in-hospital mortality in the female NSTEMI subgroup. No ECG features were found to predict in-hospital mortality in male patients. Compared to males, females with ACS often showed less frequent and less extensive ST-segment abnormalities and were more likely to have a normal initial ECG at admission. These differences could impact clinical evaluation and prognosis. Recognizing these sex-related ECG differences may help optimize the management of ACS patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02438085