Sex‐Related Differences in Clinical Features and In‐Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study

Abstract

Background The association between female sex and poor outcomes following surgery for type A acute aortic dissection has been reported; however, sex‐related differences in clinical features and in‐hospital outcomes of type B acute aortic dissection, including classic aortic dissection and intramural hematoma, remain to be elucidated. Methods and Results We studied 2372 patients with type B acute aortic dissection who were enrolled in the Tokyo Acute Aortic Super‐Network Registry. There were fewer and older women than men (median age [interquartile range]: 76 years [66–84 years], n=695 versus 68 years [57–77 years], n=1677; P <0.001). Women presented to the aortic centers later than men. Women had a higher proportion of intramural hematoma (63.7% versus 53.7%, P <0.001), were medically managed more frequently (90.9% versus 86.3%, P =0.002), and had less end‐organ malperfusion (2.4% versus 5.7%, P <0.001) and higher in‐hospital mortality (5.3% versus 2.7%, P =0.002) than men. In multivariable analysis, age (per year, odds ratio [OR], 1.06 [95% CI, 1.03–1.08]; P <0.001), hyperlipidemia (OR, 2.09 [95% CI, 1.13–3.88]; P =0.019), painlessness (OR, 2.59 [95% CI, 1.14–5.89]; P =0.023), shock/hypotension (OR, 2.93 [95% CI, 1.21–7.11]; P =0.017), non–intramural hematoma (OR, 2.31 [95% CI, 1.32–4.05]; P =0.004), aortic rupture (OR, 26.6 [95% CI, 14.1–50.0]; P <0.001), and end‐organ malperfusion (OR, 4.61 [95% CI, 2.11–10.1]; P <0.001) were associated with higher in‐hospital mortality, but was not female sex (OR, 1.67 [95% CI, 0.96–2.91]; P =0.072). Conclusions Women affected with type B acute aortic dissection were older and had more intramural hematoma, a lower incidence of end‐organ malperfusion, and higher in‐hospital mortality than men. However, female sex was not associated with in‐hospital mortality after multivariable adjustment.

Sex Differences in Adiposity and Cardiovascular Diseases

“…Following the onset of menopause, the incidence of hypertension among women begins to surpass that of men [ 118 ]. A history of hypertension and chronic obstructive pulmonary disease is more common among women [ 119 , 120 , 121 ]. In acute aortic dissection, women, at the time of diagnosis, are older than men and complain less frequently of an abrupt onset of pain [ 120 , 121 ].…”

“…A history of hypertension and chronic obstructive pulmonary disease is more common among women [ 119 , 120 , 121 ]. In acute aortic dissection, women, at the time of diagnosis, are older than men and complain less frequently of an abrupt onset of pain [ 120 , 121 ]. Obesity is considered an important risk factor for atrial fibrillation (AF), for which the incidence has increased significantly in recent years [ 122 ].…”

Gender Differences in Acute Aortic Dissection

“…Few studies have investigated the impact of gender in type B AAD [ 26 , 27 , 29 , 30 ]. Liang et al [ 29 ] identified, from 2009 to 2012, 9855 (women 43.6%, n = 4293) patients with type B AAD.…”

“…Takahashi et al [ 30 ] analyzed data about 2372 (695 women, 29.3%) patients with type B AAD, enrolled in the Tokyo Acute Super-Network Registry. Women were older than men and presented later at the emergency department.…”

“…Women were older than men and presented later at the emergency department. Women showed a higher proportion of intramural hematoma (63.7% vs. 53.7%, p < 0.001) and were more medically treated (90.9% vs. 86.3%, p = 0.002), with higher in-hospital mortality (5.3% vs. 2.7%, p = 0.002) [ 30 ]. At multivariate analysis, female gender was not associated with higher in-hospital mortality (OR 1.67 [95% CI, 0.96–2.91]) [ 30 ].…”