Gender Difference is Associated with Short-Term Outcomes in Non-Surgically Managed Acute Aortic Dissection Patients with Hypertension: A Retrospective Cohort Study

Abstract

Background The management of acute aortic dissection (AAD) has improved; however, the outcomes related to different gender with short-term outcomes in non-surgically managed AAD with hypertension are still limited. Our objective was to explore gender-differences in association with short-term outcomes of patients comorbid with hypertension in non-surgically managed AAD. Methods This is an observational retrospective single-center cohort. We analyzed the data from the Second Xiangya Hospital of Central South University (2014–2018). The data on demographics, clinical presentation, chronic comorbidities, laboratory testing, imaging studies, and treatment were analyzed for all patients. Univariate and multiple analyses were used to test gender-difference associated with short-term outcomes of patients with hypertension in non-surgically managed AAD. Results In total, 288 patients were enrolled in this study, of whom 238 (82.63%) were male and 50 (17.37%) were females. About 74% of female patients were dead in-hospital, which was more than male patients (56.3%). Female patients with diabetes mellitus were more than male patients (14% vs 2.94%), while male patients with smoking were significant higher than female patients (36.55% vs 8%). In the full model (model 3), after adjusting for confounding variables, the female AAD patients were more likely to have worse short-term outcomes (OR=3.60, 95% CI=1.41 to 9.60). Conclusion Female patients were more likely to have worse outcomes in non-surgically managed AAD patients with hypertension. Large numbers of investigations are required to further explore this relationship.

The Gender Gap in Aortic Dissection: A Prospective Analysis of Risk and Outcomes

“…It is important to take into consideration preoperative and postoperative risk factors, and the gender gap to improve aortic dissection management and decrease their impact on the outcome [ 7 , 25 ]. A focus on eligible risk factors is critical in emergency cases and their identification and good management might influence the mortality rates [ 38 ].…”

“…Inotropic and vasoconstrictor drugs, typically utilized preoperatively for persistent hypotension and postoperatively to manage vasoplegia associated with a systemic inflammatory syndrome, are related to renal dysfunction in aortic dissection, particularly in female patients [ 38 ].…”

Operative Mortality After Type A Aortic Dissection Surgery

“… 1 Sex differences in mortality among aortic dissection patients have gained attention, 2 however, data pertaining to disparities in outcomes between males and females are conflicting. 3 While some studies have demonstrated that surgically treated females with ATAAD have a higher odds of in-hospital mortality compared with males, 4 , 5 , 6 , 7 , 8 other studies have found no significant differences in in-hospital mortality between males and females after surgical repair of ATAAD. 9 , 10 , 11 , 12 A systematic review and meta-analysis reported no difference in early mortality between sexes after surgical repair of ATAAD.…”