Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China.
Chin Med J (Engl). 2018 Jun 20;131(12):1430-1435. doi: 10.4103/0366-6999.233943.
The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection (AAD) is needed. We aimed to investigate whether sex disparities are found in patients with AAD, and to study sex differences in complications, mortality in-hospital, and long-term.
We included 884 patients enrolled in our institute between June 2002 and May 2016. Considering psychosocial factors, treatments, and the outcomes in men versus those in women with AAD, we explored the association of sex with psychosocial characteristics and mortality risk. For categorical variables, significant differences between groups were assessed with the Chi-square test or Fisher's exact test, and continuous parameters were assessed with Student's t-test. Univariate and stratified survival statistics were computed using Kaplan-Meier analysis.
A total of 884 patients (76.1% male, mean age 51.4 ± 11.8 years) were included in this study. There were fewer current smokers in female compared with male (17.5% vs. 67.2%, χ = 160.06, P < 0.05). The percentage of men who reported regular alcohol consumption was significantly higher than that in women (40.6% vs. 3.8%, χ = 100.18, P < 0.05). About 6.2% (55 of 884) of patients with AAD died before vascular or endovascular surgery was performed, 34.4% (304 of 884) of patients underwent surgical procedures, and 52.7% (466 of 884) and 12.8% (113 of 884) of patients received endovascular treatment and medication. Postoperative mortality similar (6.0% vs. 5.6%, respectively, χ = 0.03, P = 0.91) between men and women. Follow-up was completed in 653 of 829 patients (78.8%). Adjustment for age, history of coronary disease, hypertension, smoking and drinking, Type A and use of beta-blocker, angiotensin II receptor blockers, angiotensin converting enzyme (ACE) inhibitor, calcium-channel blockers and statins by multivariate logistic regression analysis suggested that age (odds ratios [OR s], 1.04; 95% confidence interval [CI], 1.01-1.07; P < 0.05), using of calcium-channel blockers (OR, 0.37; 95% CI, 0.18-0.74; P < 0.05), at discharge were independent predictors of late mortality, ACE inhibitors (OR, 1.91; 95% CI, 1.03-3.54; P = 0.04) was independent risk factor of late mortality.
In Chinese with AAD, sex is not independently associated with long-term clinical outcomes. Age, the intake of calcium-channel blockers at discharge might help to improve long-term outcomes.
冠心病的患病率、表现、治疗和预后因性别而异。需要更深入地了解急性主动脉夹层（AAD）患者中男女之间的差异。我们旨在研究 AAD 患者中是否存在性别差异，并研究并发症、住院期间死亡率和长期死亡率的性别差异。
我们纳入了 2002 年 6 月至 2016 年 5 月期间在我院就诊的 884 例患者。考虑到社会心理因素、治疗方法以及男性和女性 AAD 患者的预后，我们探讨了性别与社会心理特征和死亡率风险之间的关系。对于分类变量，使用卡方检验或 Fisher 确切检验评估组间的显著差异，使用 Student's t 检验评估连续参数。使用 Kaplan-Meier 分析计算单变量和分层生存统计数据。
本研究共纳入 884 例患者（76.1%为男性，平均年龄 51.4±11.8 岁）。与男性相比，女性中当前吸烟者的比例较低（17.5%比 67.2%，χ = 160.06，P < 0.05）。报告经常饮酒的男性比例显著高于女性（40.6%比 3.8%，χ = 100.18，P < 0.05）。在接受血管或血管内手术之前，约有 6.2%（55/884）的 AAD 患者死亡，34.4%（304/884）的患者接受了手术治疗，52.7%（466/884）和 12.8%（113/884）的患者接受了血管内治疗和药物治疗。男性和女性的术后死亡率相似（分别为 6.0%和 5.6%，χ = 0.03，P = 0.91）。在 829 例患者中有 653 例（78.8%）完成了随访。通过多变量逻辑回归分析调整年龄、冠心病史、高血压、吸烟和饮酒、A型和β受体阻滞剂、血管紧张素 II 受体阻滞剂、血管紧张素转换酶（ACE）抑制剂、钙通道阻滞剂和他汀类药物的使用情况后，发现年龄（比值比[OR]，1.04；95%置信区间[CI]，1.01-1.07；P < 0.05）、出院时使用钙通道阻滞剂（OR，0.37；95% CI，0.18-0.74；P < 0.05）是晚期死亡率的独立预测因素，ACE 抑制剂（OR，1.91；95% CI，1.03-3.54；P = 0.04）是晚期死亡率的独立危险因素。
在中国 AAD 患者中，性别与长期临床结局无关。年龄、出院时钙通道阻滞剂的使用可能有助于改善长期预后。
