Sex Differences in DeBakey Type I/II Acute Aortic Dissection Outcomes: The Tokyo Acute Aortic Super-network

Area of Science:

• Cardiovascular Medicine
• Thoracic Surgery
• Medical Research

Background:

• Sex differences in clinical presentation and outcomes of DeBakey type I/II (Stanford type A) acute aortic dissection (AAD) are not well understood.
• AAD is a life-threatening condition requiring prompt diagnosis and management.

Purpose of the Study:

• To investigate the impact of sex on the clinical presentation and in-hospital outcomes of patients with type I/II AAD.
• To compare outcomes between surgically and medically treated AAD patients based on sex.

Main Methods:

• Analysis of 3,089 patients with type I/II AAD from a multicenter Japanese registry (2013-2018).
• Patients were stratified into surgical (n=2,543) and medical (n=546) treatment groups.
• Multivariable logistic regression was employed to assess the association between sex and in-hospital mortality.

Main Results:

• Women with AAD were older and presented with more comorbidities including hyperlipidemia, stroke history, altered consciousness, and shock.
• In the surgical group, men exhibited higher rates of preoperative end-organ malperfusion and in-hospital mortality (OR: 1.71; P < 0.001).
• In the medical group, women had higher rates of cardiac tamponade and in-hospital mortality, but no significant sex difference in mortality was observed after adjustment.

Conclusions:

• Male sex is an independent predictor of higher in-hospital mortality following surgical intervention for type I/II AAD.
• No significant association between sex and in-hospital mortality was found in medically treated patients.
• Further investigation into the underlying mechanisms contributing to poorer surgical outcomes in men with AAD is warranted.