Sex differences in electrocardiographic patterns among patients with acute coronary syndromes
- 1Cardiology Unit, Sant’Anna University Hospital, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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
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BibTeX
@article{vitali2026differences,
title = {{Sex differences in electrocardiographic patterns among patients with acute coronary syndromes}},
author = {Francesco Vitali and Giorgia Azzolini and Marco Zuin and Nicola Bianchi and Michele Malagù and Martina De Raffele and Anna Cantone and Federico Sanguettoli and Federico Gibiino and Cristina Balla and Elisabetta Tonet and Rita Pavasini and Gianluca Campo and Matteo Bertini},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1758485},
url = {https://doi.org/10.3389/fcvm.2026.1758485},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sex differences in electrocardiographic patterns among patients with acute coronary syndromes
AU - Francesco Vitali
AU - Giorgia Azzolini
AU - Marco Zuin
AU - Nicola Bianchi
AU - Michele Malagù
AU - Martina De Raffele
AU - Anna Cantone
AU - Federico Sanguettoli
AU - Federico Gibiino
AU - Cristina Balla
AU - Elisabetta Tonet
AU - Rita Pavasini
AU - Gianluca Campo
AU - Matteo Bertini
PY - 2026
DA - 2026/10/12
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1758485
UR - https://doi.org/10.3389/fcvm.2026.1758485
AB - 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
SN - 2297-055X
ER -