Journal of the American Heart Association · 2026
Sex-Related Differences in Clinical Profile, Management, and Outcomes of Patients With Type A and B Acute Aortic Dissection: Observations From IRAD.
СтатьяСравнительное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Jackson Elizabeth, Carbone Andreina, Shalhub Sherene, Pai Chih-Wen, Ehrlich Marek, Suzuki Toru, Hughes G Chad, Bhan Anil, Faizer Rumi, Cittadini Antonio, Braverman Alan, Isselbacher Eric, Eagle Kim, Nienaber Christoph, Bossone Eduardo
Аннотация
BACKGROUND: Available data about sex differences in patients with acute aortic dissection (AAD) are scant and conflicting. The aim of this study is to assess sex-related differences in clinical characteristics, presentation, diagnostic findings, management, and outcomes among patients with type A (TA-AAD) and type B AAD (TB-AAD).
METHODS: Data about 11 586 patients enrolled in the IRAD (International Registry of Acute Aortic Dissection) from 1996 to 2022, were analyzed; 7819 (67.5%) experienced TA-AAD and 3867 (33.0%) TB-AAD. Men and women were compared with regard to diagnosis, treatment, and in-hospital and long-term survival.
RESULTS: One third of patients were women (TA-AAD, 34.4%; and TB-AAD, 34.5%). Women were older than men for both types of AAD. The median time from hospital admission to diagnosis was longer in women for both TA-AAD and TB-AAD (P<0.001). For TA-AAD, symptoms of hypotension and coma/altered mental status were more common in women, whereas for TB-AAD women were more likely to present with congestive heart failure. Surgical repair for TA-AAD was less frequent in women than men (84.6% versus 89.0%; P<0.001). For both types of AAD, medical management was more common among women than men (TA-AAD, 16.5% versus 11.6%; P<0.001; TB-AAD, 65.6% versus 54.2%; P<0.001). The overall as well as surgical in-hospital mortality rate was higher among women with TA-AAD compared with men (P<0.001), whereas it was similar in those managed medically (P=0.23). No difference in overall (P=1), medical (P=0.38), endovascular (P=1), and surgical (P=0.51) mortality rates was observed for TB-AAD between men and women. After TA-AAD, women showed lower 4-year survival compared with men (81.4% versus 86.6%, P<0.001).
CONCLUSIONS: The present study highlights important sex-related differences in AAD; there is a need to design tailored aortic disease management programs to improve outcomes in women.
METHODS: Data about 11 586 patients enrolled in the IRAD (International Registry of Acute Aortic Dissection) from 1996 to 2022, were analyzed; 7819 (67.5%) experienced TA-AAD and 3867 (33.0%) TB-AAD. Men and women were compared with regard to diagnosis, treatment, and in-hospital and long-term survival.
RESULTS: One third of patients were women (TA-AAD, 34.4%; and TB-AAD, 34.5%). Women were older than men for both types of AAD. The median time from hospital admission to diagnosis was longer in women for both TA-AAD and TB-AAD (P<0.001). For TA-AAD, symptoms of hypotension and coma/altered mental status were more common in women, whereas for TB-AAD women were more likely to present with congestive heart failure. Surgical repair for TA-AAD was less frequent in women than men (84.6% versus 89.0%; P<0.001). For both types of AAD, medical management was more common among women than men (TA-AAD, 16.5% versus 11.6%; P<0.001; TB-AAD, 65.6% versus 54.2%; P<0.001). The overall as well as surgical in-hospital mortality rate was higher among women with TA-AAD compared with men (P<0.001), whereas it was similar in those managed medically (P=0.23). No difference in overall (P=1), medical (P=0.38), endovascular (P=1), and surgical (P=0.51) mortality rates was observed for TB-AAD between men and women. After TA-AAD, women showed lower 4-year survival compared with men (81.4% versus 86.6%, P<0.001).
CONCLUSIONS: The present study highlights important sex-related differences in AAD; there is a need to design tailored aortic disease management programs to improve outcomes in women.