Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective

Presentation, management, and clinical outcomes of acute type A dissection: Does sex matter?Central MessagePerspective

Background: Male–female differences in clinical presentation, management, and outcomes of acute type A aortic dissection (AD-A) have been reported; however, robust data are scarce. This study examined those differences. Methods: Consecutive adults diagnosed with AD-A between 2007 and 2017 in 4 refer...

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Main Authors: Frederike Meccanici, BSc, Carlijn G.E. Thijssen, MD, PhD, Arjen L. Gökalp, MD, Marie H.E.J. van Wijngaarden, MD, Mark F.A. Bierhuizen, MD, Guy F. Custers, MD, Jort Evers, BSc, Jolien A. de Veld, MD, Maximiliaan L. Notenboom, BSc, Guillaume S.C. Geuzebroek, MD, PhD, Joost F.J. ter Woorst, MD, PhD, Jelena Sjatskig, MD, Robin H. Heijmen, MD, PhD, Mostafa M. Mokhles, MD, PhD, Roland R.J. van Kimmenade, MD, PhD, Jos A. Bekkers, MD, PhD, Johanna J.M. Takkenberg, MD, PhD, Jolien W. Roos-Hesselink, MD, PhD
Format: Article
Language:English
Published: Elsevier 2025-04-01
Series:JTCVS Open
Subjects:
Stanford type A aortic dissection
clinical presentation
outcomes
survival
sex
gender
Online Access:http://www.sciencedirect.com/science/article/pii/S2666273624004431
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Summary:Background: Male–female differences in clinical presentation, management, and outcomes of acute type A aortic dissection (AD-A) have been reported; however, robust data are scarce. This study examined those differences. Methods: Consecutive adults diagnosed with AD-A between 2007 and 2017 in 4 referral centers were included retrospectively. Baseline data, operative characteristics, and mortality and morbidity during follow-up were collected using patient files, questionnaires, and referral information. Results: The study included 889 patients (37.5% female). Females were significantly older at presentation (median, 67.0 [interquartile range [IQR], 59.0-75.0] years vs 61.0 [IQR, 53.0-69.0] years; P < .001) and more often had cardiovascular comorbidities. Severe hypotension, tamponade, and nausea were more frequently observed in females. Short-term mortality was 18.5% in females and 21.2% in males (P = .362). No significant differences in treatment between males and females were observed. After surgery, the median follow-up was 6.2 years (IQR, 3.5-9.2 years). Overall 10-year survival was 50.1% (95% confidence interval [CI], 43.6%-57.6%) in females and 62.8% (95% CI, 58.1%-67.9%) in males (P = .009), although this difference was not significant after multivariable correction. Compared to the matched general population, survival was lower than expected in females and comparable to expected in males. The long-term reintervention rate in surgically treated survivors was comparable between males and females (2.1%/patient-year). Male- and female-specific risk factors for long term mortality were identified. Conclusions: These findings highlight a distinct clinical profile at presentation with AD-A between males and females, while treatment approach and short-term mortality were comparable. The relatively poor long-term survival in females and male-/female-specific risk stratification warrant further investigation.
ISSN:2666-2736

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