Sex Difference Analysis after Aortic Dissection from The Houston Aortic Collaborative Experience

P0298 

Abstract Submission 

Lucas Ribe (1), Rana Afifi (2), Yuki Ikeno (1), Akiko Tanaka (3), Charles Miller (4), Harleen Sandhu (5), Gustavo Oderich (1), Anthony Estrera (3)

(1) McGovern Medical School at UTHealth, Houston, TX, (2) Memorial Hermann, Houston, TX, (3) Memorial Hermann Heart and Vascular Institute, Houston, TX, (4) Memorial Hermann Texas Medical Center, Houston, TX, (5) N/A, HOUSTON, TX

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Rana Afifi    -  Contact Me
Memorial Hermann

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Charles Miller    -  Contact Me
Memorial Hermann Texas Medical Center

Harleen Sandhu    -  Contact Me
N/A

Gustavo Oderich    -  Contact Me
McGovern Medical School at UTHealth

*Anthony Estrera    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Objective

Data on sex-related differences in presentation, management, and clinical outcome in acute aortic dissection (AAD) are scarce, especially for acute type A (AAAD) and acute type B (ABAD) subtypes.
The aim was to determine the effect of sex on AAD presentation, management and outcomes in a large cohort of patients from two major aortic surgery centers.

Methods

We retrospectively reviewed the two-institution clinical data of all consecutive patients treated for AAD from 2000 to 2023. Data were analyzed by univariate and multivariable methods for short- and long-term data. Cox multivariable analyses were restricted to 3 years' follow-up.

Results

Overall, 2,269 patients treated for AADs with 1,380 AAAD and 889 ABAD. Median age was 60 years (IQR:50-71); 779 (34%) were women. Women were older (63 vs 58 yrs; P<.001), had lower baseline renal function (39% vs 26%, p<.001) and more genetically triggered aortic disease (11% vs 7%, P=.008). Clinical presentation is shown in Table. Women had fewer renal (13% vs 18%; P=.004), bleeding (13% vs 19%; P=.001), and GI (24% vs 28%; P=.049) in-hospital complications. 30-day mortality was not different between groups (11% vs 13%; P=.134). There was no significant difference in mid or long-term survival by sex overall, but Kaplan Meir analysis suggest a possible difference in the type A group, notably in the first 3 years (Figure 1, p<.001). Among AAAD cases, risk factors for mid (3-years) and long-term mortality were examined to assess the independent effect of female sex. Absolute risk difference of midterm mortality attributable to COPD in stratified analysis was 15% in women (p<.01). Multivariable risk factors for midterm and long term mortality after AAAD were female (HR 1.4, p<.02), rupture (HR 2.0, p<.001), CAD (HR 1.7, p<.001), mesenteric MPS (HR 2.3, p<.001). After adjusting for these risk factors, midterm as well as long-term survival among women with AAAD was significantly lower compared to males (Figure 2, p<.017).

Conclusions

Women with AAD presented at an older age with poor baseline renal function and had higher prevalence of genetic disease and ABAD. 3-year adjusted survival for women with AAAD was worse than men; COPD may modify risk by sex. Independent risk factors for mid and long-term mortality after AAAD included rupture, mesenteric malperfusion, CAD, and female sex.

Dissection