Sex-Based Differences in Long-Term Outcomes of Patients With Ascending Aortic Dilation
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View abstract on PubMed
Summary
This summary is machine-generated.Women with thoracic ascending aortopathy (AA) experience worse long-term survival despite fewer comorbidities and higher surgical rates. These findings suggest a need for sex-specific thresholds in AA surgical recommendations.
Area Of Science
- Cardiology
- Vascular Surgery
- Medical Research
Background
- Thoracic ascending aortopathy (AA) is often asymptomatic and diagnosed incidentally.
- Surgical replacement is typically recommended once AA becomes aneurysmal.
- This study investigates sex-based differences in AA patient characteristics and outcomes.
Purpose Of The Study
- To analyze sex-based characteristics and long-term outcomes in patients with thoracic ascending aortopathy (AA).
- To compare comorbidities, aortic measurements, and surgical intervention rates between men and women with AA.
- To identify factors influencing mortality and survival in AA patients based on sex.
Main Methods
- Analysis of 14,244 patients with unrepaired AA (≥4 cm) diagnosed via echocardiography (2010-2023).
- Exclusion of patients with acute aortic dissection/rupture at presentation.
- Collection of baseline data, including height-indexed aortic measurements, and recording of AA surgery and dissection/rupture events. Cox proportional hazards and Kaplan-Meier survival analyses were performed.
Main Results
- Women were older, had fewer comorbidities, but higher height-indexed aortic measurements compared to men.
- Despite higher surgical rates in women (28.2% vs 25.6%), they exhibited worse long-term survival (14.2% vs 11.2%).
- Female sex was independently associated with higher mortality (HR, 1.14), while aortic surgery improved survival (HR, 0.81). Unoperated women with aortic diameters <5 cm accounted for a significant proportion of deaths and dissections/ruptures.
Conclusions
- Women with AA demonstrate poorer long-term survival outcomes compared to men, even with fewer comorbidities and higher surgical intervention rates.
- The findings suggest that current surgical thresholds for AA may not be optimal for women.
- Consideration of sex-specific thresholds for AA surgery is warranted to improve patient outcomes.
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