TY - JOUR
T1 - Presentation, management, and clinical outcomes of acute type A dissection
T2 - Does sex matter?
AU - Meccanici, Frederike
AU - Thijssen, Carlijn G.E.
AU - Gökalp, Arjen L.
AU - van Wijngaarden, Marie H.E.J.
AU - Bierhuizen, Mark F.A.
AU - Custers, Guy F.
AU - Evers, Jort
AU - de Veld, Jolien A.
AU - Notenboom, Maximiliaan L.
AU - Geuzebroek, Guillaume S.C.
AU - ter Woorst, Joost F.J.
AU - Sjatskig, Jelena
AU - Heijmen, Robin H.
AU - Mokhles, Mostafa M.
AU - van Kimmenade, Roland R.J.
AU - Bekkers, Jos A.
AU - Takkenberg, Johanna J.M.
AU - Roos-Hesselink, Jolien W.
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/12/16
Y1 - 2024/12/16
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85214562041&partnerID=8YFLogxK
U2 - 10.1016/j.xjon.2024.12.006
DO - 10.1016/j.xjon.2024.12.006
M3 - Article
AN - SCOPUS:85214562041
SN - 2666-2736
JO - JTCVS Open
JF - JTCVS Open
ER -