Male–female differences in acute thoracic aortic dissection: a systematic review and meta-analysis

Abstract

“Male-female differences were found in baseline and treatment characteristics in adults with AD but not in deaths”, could you change “deaths” into “mortality”? OBJECTIVES This study aims to systematically review published literature on male–female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD). METHODS A systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan–Meier curves. RESULTS Nine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P < 0.001) and AD-B (P < 0.001), and in AD-A patients males had more distally extended dissections [OR 0.57, 95% confidence interval (CI) 0.46–0.70; P < 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17–0.41; P < 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58–0.72; P < 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84–1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83–1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male–female difference, whereas male patients had more reinterventions during follow-up. CONCLUSIONS This systematic review shows male–female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male–female characteristics and outcomes are clearly warranted. Improved knowledge of male–female differences in AD will help shape optimal individualized care for both males and females. Clinical registration number PROSPERO, ID number: CRD42020155926.

Risk Factors for Thoracic Aortic Dissection

“…Sex was not associated with short-term or long-term mortality in type B AAD patients who underwent thoracic endovascular aortic repair (TEVAR) [ 18 , 26 , 27 ]. As aortic valve-sparing root replacement and antegrade cerebral perfusion strategies during arch reconstruction increased over the past decade, in-hospital mortality due to type A AADs has decreased in both men and women [ 15 , 21 , 27 ], mitigating sex differences in short-term outcomes was found to disappear in several recent studies [ 20 , 23 , 27 , 28 , 29 , 30 ]. Despite these improvements, women with type A AAD are more likely to suffer neurological dysfunction due to decreased perfusion or ischemia prior to intervention and post-operation [ 21 , 22 , 31 ].…”

Gender differences in acute aortic syndromes

“…There is evidence that female ATAAD patients have less abrupt onset of chest and back pain [11]. A more insidious onset of symptoms could be one reason why female patients present later to hospitals than male individuals for both ATAAD and ATBAD [11,16 ▪▪ ,19 ▪▪ ]. Additionally, women are more likely to experience delays in diagnosis of ATAAD (median time from presentation to diagnosis of 6.40 vs. 3.96 h; P = 0.001) [48].…”

More insights into acute aortic dissection, but with what clinical consequence?

“…connective tissue disorders, bicuspid aortic valves, various aneurysm formations, positive family history, etc.). What is known is that the aorta changes with age [ 2 ] and that there are specific gender differences in AAD [ 3 ]. Therefore, the relatively small number of patients in this study, the ratio male:female of 7:3, as well as the age range between 27 and 75 years may represent different biochemical and biomechanical findings of the aortas itself.…”