Gender-Related Differences in Presentation and Outcome of Acute Type a Aortic Dissection

Abstract

Background: Although acute type-A aortic dissection (AAOD) is more common in males, the course of the disease may differ in females. Objectives: We aimed to investigate the gender-related differences in patients with AAOD with regard to clinical presentation, short-term and long-term mortality. Patients and Methods: Medical records of 192 patients with a confirmed diagnosis of AAOD in a University Heart Center from March 2004 through October 2015 were evaluated. Clinical information, hospital mortality, and long-term survival were explored with regard to gender. Propensity matching was performed to adjust for baseline differences. Kaplan-Meier survival analysis was used to determine the impact of gender on long-term mortality. Results: Among 192 patients, 71 (37.0%) were females. The women were older (65.7 +/- 13.8 vs. 53.9 +/- 15.1 years, P < 0.001). Hypertension (77.5% vs. 56.7%; P = 0.006) and diabetes mellitus (12.7% vs. 0.1%; P = 0.001) were more common among women than men, while active smoking was significantly more prevalent in men (46.7% vs. 9.9%; P < 0.001). The frequency of various clinical presentations was not different between the two groups. Among men, 71.7% were surgically managed compared to 67.6% among women. In-hospital mortality was 50.7% in women and 42.1% in men and remained statistically similar after matching. For long-term survival female to male hazard ratio (HR) was 1.24 with 95% CI: 0.85 - 1.81 (P = 0.257), which basically remained unchanged after propensity matching, HR was 1.13, 95% CI: 0.73 - 1.73 (P = 0.300). Conclusions: In patients admitted with AAOD, there was no gender-related differences in clinical presentation and type of management. Similarly, hospital and long-term mortality did not differ with regard to gender.