Male-Female Differences in Acute Type B Aortic Dissection
Meccanici, Frederike; Thijssen, Carlijn G E; Heijmen, Robin H; Geuzebroek, Guillaume S C; Ter Woorst, Joost F; Gökalp, Arjen L; de Bruin, Jorg L; Gratama, Daantje N; Bekkers, Jos A; van Kimmenade, Roland R J; Poyck, Paul; Peels, Kathinka; Post, Marco C; Mokhles, Mostafa M; Takkenberg, Johanna J M; Roos-Hesselink, Jolien W; Verhagen, Hence J M
(2024) Journal of the American Heart Association, volume 13, issue 1
(Article)
Abstract
BACKGROUND: Acute type B aortic dissection is a cardiovascular emergency with considerable mortality and morbidity risk. Male–female differences have been observed in cardiovascular disease; however, literature on type B aortic dissection is scarce. METHODS AND RESULTS: A retrospective cohort study was conducted including all consecutive patients with acute type B
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aortic dissection between 2007 and 2017 in 4 tertiary hospitals using patient files and questionnaires for late morbidity. In total, 384 patients were included with a follow-up of 6.1 (range, 0.02–14.8) years, of which 41% (n=156) were female. Women presented at an older age than men (67 [interquartile range (IQR), 57–73] versus 62 [IQR, 52–71]; P=0.015). Prior abdominal aortic aneurysm (6% versus 15%; P=0.009), distally extending dissections (71 versus 85%; P=0.001), and clinical malperfusion (18% versus 32%; P=0.002) were less frequently observed in women. Absolute maximal descending aortic diameters were smaller in women (36 [IQR: 33–40] mm versus 39 [IQR, 36–43] mm; P<0.001), while indexed for body surface area diameters were larger in women (20 [IQR, 18–23] mm/m2 versus 19 [IQR, 17–21] mm/m2). No male–female differences were found in treatment choice; however, indications for invasive treatment were different (P<0.001). Early mortality rate was 9.6% in women and 11.8% in men (P=0.60). The 5-year survival was 83% (95% CI, 77–89) for women and 84% (95% CI, 79–89) for men (P=0.90). No male–female differences were observed in late (re)interventions. CONCLUSIONS: No male–female differences were found in management, early or late death, and morbidity in patients presenting with acute type B aortic dissection, despite distinct clinical profiles at presentation. More details on the impact of age and type of intervention are warranted in future studies.
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Keywords: Acute Disease, Aortic Aneurysm, Thoracic/surgery, Aortic Dissection/epidemiology, Blood Vessel Prosthesis Implantation, Endovascular Procedures, Female, Humans, Male, Retrospective Studies, Risk Factors, Treatment Outcome, thoracic aortic dissection, gender, sex, Stanford type B dissection, Cardiology and Cardiovascular Medicine, Journal Article
ISSN: 2047-9980
Publisher: Wiley-Blackwell
Note: Publisher Copyright: © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
(Peer reviewed)