O-156 - MALE-FEMALE DIFFERENCES IN ACUTE TYPE B AORTIC DISSECTION: THE DISSEXION STUDY

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Meccanici F. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , Thijssen C. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , Gökalp A. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , De Bruin J. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , Bekkers J. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , Van Kimmenade R. (Radboud University Medical Centre ~ Nijmegen ~ Netherlands) , Geuzebroek G. (Radboud University Medical Centre ~ Nijmegen ~ Netherlands) , Poyck P. (Radboud University Medical Centre ~ Nijmegen ~ Netherlands) , Ter Woorst J. (Catharina Hospital ~ Eindhoven ~ Netherlands) , Peels K. (Catharina Hospital ~ Eindhoven ~ Netherlands) , Post M. (St. Antonius Hospital ~ Nieuwegein ~ Netherlands) , Heijmen R. (St. Antonius Hospital ~ Nieuwegein ~ Netherlands) , Mokhles M. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , Takkenberg J. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , Roos-Hesselink J. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands) , Verhagen H. (Erasmus University Medical Centre ~ Rotterdam ~ Netherlands)
Introduction:
Acute type B aortic dissection (ATBAD) is a cardiovascular emergency with high risk of morbidity and mortality. Elucidating male-female differences in ATBAD might help optimize patient-specific care, while data is scarce on this topic. The aim of this study was to identify differences between male and female ATBAD patients in presentation, management and outcomes.
Methods:
A retrospective cohort study was conducted including all consecutive patients who presented with ATBAD between 2007-2017 in four tertiary centers. Non-acute, traumatic, and iatrogenic dissections were excluded. We included patients presenting with an intramural hematoma or penetrating aortic ulcer in the acute setting.
Results:
The study population consisted of 384 patients, of which 41% (n=156) was female. In comparison to males, females presented at an older age (67 [IQR:57-73] vs. 62 [IQR:52-71], p=0.015) and fewer female patients had a history of abdominal aortic aneurysm (6% vs. 15%, p=0.009). Imaging diagnostics revealed a smaller proportion of patients with distally extended dissections in females. DeBakey type IIIb was diagnosed less frequently in females (73% vs. 85%, p=0.008) as was renal artery involvement (48% vs. 66%, p=0.009). Furthermore, classical type B dissection was less often observed in female patients compared to male patients (56% vs. 78%, p<0.001). Absolute maximum thoracic aortic diameters were not significantly different in females and males (44.0 [38.0-50.0] mm vs. 42.0 [39.0-49.0], p=0.870). No male-female differences were found in treatment strategy (p=0.561, Figure 1). In-hospital/30-day mortality was 9.6% in female patients and 11.8% in male patients (p=0.603). Long-term mortality did not show a significant male-female difference (p=0.90) during a median follow-up duration of 6.1 [IQR:4.1-9.1] years (Figure 2).
Conclusion:
This study showed that female patients were older at presentation, while male patients more often had distally extended dissections. Although mortality was not significantly different, we encourage male-female specific risk factor studies on late mortality. In this way ATBAD male and female patients at high risk of mortality can be identified and patient-specific care can be implemented.
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