Gender-related differences in acute aortic dissection.
BACKGROUND
Few data exist on gender-related differences in clinical presentation, diagnostic findings, management, and outcomes in acute aortic dissection (AAD).


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 (P=0.008); 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, P=0.04), predominantly in the 66- to 75-year age group. Moreover, surgical outcome was worse in women than men (P=0.013); 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.
Nienaber
Christoph A
CA
Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany. christoph.nienaber@med.uni-rostock.de
Fattori
Rossella
R
Mehta
Rajendra H
RH
Richartz
Barbara M
BM
Evangelista
Arturo
A
Petzsch
Michael
M
Cooper
Jeanna V
JV
Januzzi
James L
JL
Ince
Hüseyin
H
Sechtem
Udo
U
Bossone
Eduardo
E
Fang
Jianming
J
Smith
Dean E
DE
Isselbacher
Eric M
EM
Pape
Linda A
LA
Eagle
Kim A
KA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D002305:Cardiac Tamponade / Q000453:epidemiology / Q000209:etiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D019090:Case Management / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D003244:Consciousness Disorders / Q000453:epidemiology / Q000209:etiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D002317:Cardiovascular Agents