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Population-based Study Of Sex Differences In The Management And Outcomes Of Type B Aortic Dissection
Oonagh Scallan, Luc Dubois, Shane Smith, John Landau, Jane Newman, Audra Duncan.
Western University, London, ON, Canada.
Objective Sex differences in presentation and outcomes are poorly described for type B aortic dissection (TBAD), as prior studies are limited by small cohorts and short follow-up. A better characterization of sex differences in TBAD is needed to guide care and improve outcomes.
MethodsA population-based retrospective cohort study of TBAD identifying cases between 2007 and 2022 using regional data. Outcomes included all-cause mortality, surgical consult after index admission, surgical intervention after index admission, readmission, aortic rupture and a composite outcome of mortality, stroke, or myocardial infarction (MI). Cox proportional hazard analysis was performed to identify independent predictors of each outcome.
ResultsThe study included 8,660 patients, 3,311 (38.2%) women. Females were older (median age 75, IQR 65-83) compared to men (median age 68, IQR 58-77) (p<.0001). Although both sexes had a similar Charlson Comorbidity Index, females presented with higher rates of CHF (28.2% vs 23.6%, p<.0001), COPD (33.7% vs 27.0, p<.0001), hypertension (84.0% vs 80.5%, p<.0001), and dementia (9.4% vs 5.2%, p<.0001). Surgical consultation rates were low for both sexes (20.5% vs 21.5%), though men were more likely to receive post-discharge consultation (HR 1.12; 95% CI, 1.03-1.22). Women were less likely to undergo surgical intervention during index admission (7.2% vs 9.5%, p=0.0002). For all-comers, male sex was associated with lower mortality (HR 0.93; 95% CI, 0.86-1.00) (Figure 1) and lower risk of the composite outcome (HR 0.90; 95% CI, 0.84-0.96). Reintervention was associated with mortality (HR 2.43; 95% CI, 1.78-3.32). Aneurysmal degeneration was common (66%), did not differ by sex, and was associated with higher mortality but not rupture. Only 9.6% of men and 7.7% of women had at least one annual imaging study during the 5-year follow-up period.
ConclusionsWomen with TBAD experience greater comorbidity, at more advanced age, had less surgical intervention, and have higher overall mortality compared to men. Surgical referral and imaging surveillance were poor for both sexes, exposing gaps in aortic care that warrant targeted efforts to improve referral pathways, structured surveillance programs, and long-term outcomes for all patients with TBAD.
Figure 1. Kaplan Meier curve for mortality
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