Sex‐Related Differences in Clinical Features and In‐Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study
Toshiyuki Takahashi, Hideaki Yoshino, Koichi Akutsu, Tomoki Shimokawa, Hitoshi Ogino, Takashi Kunihara, Michio Usui, Kazuhiro Watanabe, Mitsuhiro Kawata, Hiroshi Masuhara, Manabu Yamasaki, Takeshi Yamamoto, Ken Nagao, Morimasa Takayama
Abstract
Background The association between female sex and poor outcomes following surgery for type A acute aortic dissection has been reported; however, sex‐related differences in clinical features and in‐hospital outcomes of type B acute aortic dissection, including classic aortic dissection and intramural hematoma, remain to be elucidated. Methods and Results We studied 2372 patients with type B acute aortic dissection who were enrolled in the Tokyo Acute Aortic Super‐Network Registry. There were fewer and older women than men (median age [interquartile range]: 76 years [66–84 years], n=695 versus 68 years [57–77 years], n=1677; P <0.001). Women presented to the aortic centers later than men. Women had a higher proportion of intramural hematoma (63.7% versus 53.7%, P <0.001), were medically managed more frequently (90.9% versus 86.3%, P =0.002), and had less end‐organ malperfusion (2.4% versus 5.7%, P <0.001) and higher in‐hospital mortality (5.3% versus 2.7%, P =0.002) than men. In multivariable analysis, age (per year, odds ratio [OR], 1.06 [95% CI, 1.03–1.08]; P <0.001), hyperlipidemia (OR, 2.09 [95% CI, 1.13–3.88]; P =0.019), painlessness (OR, 2.59 [95% CI, 1.14–5.89]; P =0.023), shock/hypotension (OR, 2.93 [95% CI, 1.21–7.11]; P =0.017), non–intramural hematoma (OR, 2.31 [95% CI, 1.32–4.05]; P =0.004), aortic rupture (OR, 26.6 [95% CI, 14.1–50.0]; P <0.001), and end‐organ malperfusion (OR, 4.61 [95% CI, 2.11–10.1]; P <0.001) were associated with higher in‐hospital mortality, but was not female sex (OR, 1.67 [95% CI, 0.96–2.91]; P =0.072). Conclusions Women affected with type B acute aortic dissection were older and had more intramural hematoma, a lower incidence of end‐organ malperfusion, and higher in‐hospital mortality than men. However, female sex was not associated with in‐hospital mortality after multivariable adjustment.