Gender-Related Differences in Acute Aortic Dissection

Abstract

Background-Few data exist on gender-related differences in clinical presentation, diagnostic findings, management, and outcomes in acute aortic dissection (AAD). Methods and Results-Accordingly, we evaluated 1078 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) to assess differences in clinical features, management, and in-hospital outcomes between men and women. Of the patients enrolled in IRAD (32.1%) with AAD, 346 were women. Although less frequently affected by AAD (32.1% of AAD), women were significantly older and had more often presented later than men (Pϭ0.008); symptoms of coma/altered mental status were more common, whereas pulse deficit was less common. Diagnostic imaging suggestive of rupture, ie, periaortic hematoma, and pleural or pericardial effusion were more commonly observed in women. In-hospital complications of hypotension and tamponade occurred with greater frequency in women, resulting in higher in-hospital mortality compared with men. After adjustment for age and hypertension, women with aortic dissection die more frequently than men (OR, 1.4, Pϭ0.04), predominantly in the 66-to 75-year age group. Moreover, surgical outcome was worse in women than men (Pϭ0.013); type A dissection in women was associated with a higher surgical mortality of 32% versus 22% in men despite similar delay, surgical technique, and hemodynamics. Conclusions-Our analysis provides insights into gender-related differences in AAD with regard to clinical characteristics, management, and outcomes; important diagnostic and therapeutic implications may help shed light on aortic dissection in women to improve their outcomes.

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

“…Earlier studies have identified long‐term predictors of morbidity and mortality in AAD, including old age,13, 14 female sex,15 a history of atherosclerosis,4 and impaired renal function,16 all of which may be more representative of a patient's high‐risk clinical background than the severity and nature of the AAD itself. Indeed, as of yet, there may be no effective and simple marker available for evaluating severity of AAD, predicting long‐term clinical outcomes, and optimizing surgical management.…”

Impact of Aortic Aneurysm on Hospitalizations in Patients with Marfan Syndrome: A Multi-Institutional Study

“…Unexpectedly, the mortality rate was low for patients with AAD, as only one death occurred during the study period. Prior authors have reported the mortality rate for AAD, whether with or without MFS, to range from 18-38 % in pediatric and adult groups [4,5,10,15]. Using the PHIS database, Shamszad et al [11] reported that AAD was rare in pediatric patients with connective tissue diseases, including MFS, Ehlers-Danlos syndrome, and others, and mortality was 22.2 %.…”

Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak

“…According to the Stanford classification, acute type A dissection was defined as any dissection that involved the ascending aorta and/or aortic arch and acute type B as that involving the descending aorta (without any tear in or involvement of the ascending aorta) presenting within 14 days of symptom onset [6,7]. ELs were defined as leakage of CM outside the graft, but within the aneurysm sac and were classified into five types depending upon the origin of the leak (Table 1) [8e10].…”