倾向评分匹配的急性A型主动脉夹层患者临床表现及预后的性别差异

Sex Differences of Clinical Presentation and Outcomes in Propensity-Matched Patients with Acute Type A Aortic Dissection.

作者信息

Li Yang, Yang Nan, Liu Siqi, Duan Weixun, Zeng Min, Yi Dinghua

机构信息

Department of Cardiac Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Department of Stomatology, The 8th Medical Center of PLA, Beijing, China.

出版信息

Heart Surg Forum. 2021 Mar 30;24(2):E311-E316. doi: 10.1532/hsf.3615.

DOI:10.1532/hsf.3615

PMID:33798045

Abstract

OBJECTIVES

To assess sex differences of clinical presentation and outcomes in propensity-matched patients with acute type A aortic dissection (AAAD).

METHODS

We collected the clinical data of patients with AAAD from a single heart center between January 2009 and July 2014. After propensity score matching, we compared differences in clinical presentation and outcomes of patients with AAAD between men and women.

RESULTS

There were 590 patients (295 men and 295 women) with AAAD through propensity matching on demographics and patients' history. We found that the presentation and diagnosis of AAAD often were more delayed in women. Severe signs of congestive heart failure (9.8% vs. 5.1%, P = 0.017), cardiac tamponade/shock (9.1% vs. 4.1%, P < 0.001), and periaortic hematoma (26.4% vs. 21.7%, P < 0.001) were more commonly presented in women. Surgery was more commonly performed in men than in women (95.4% (281/295) vs. 91.5% (270/295), P = 0.045), indicating the association of sex with surgical decision. To investigate the association of sex with outcomes after surgery, patients who underwent surgical treatment were re-matched (262 men and 262 women) by propensity score. Women suffered from greater in-hospital mortality than men (8.4% vs. 3.4%, P < 0.001). Postoperative complications of congestive heart failure (9.1% vs. 3.8%, P < 0.001), visceral ischemia (6.8% vs. 1.1%, P < 0.001), and limb ischemia (7.6% vs. 1.5%, P < 0.001) were more frequent in women. For women, prolonged operative time may increase in-hospital mortality, especially after 12 hours from the start of surgery (30.0% vs. 14.3%, P < 0.001). Kaplan-Meier survival analysis indicated worse late outcomes in women in the matched surgery group (log-rank P = 0.012).

CONCLUSIONS

Our analysis provides new insights into sex differences in clinical presentation and outcomes of AAAD.

摘要

目的

评估倾向评分匹配后的急性A型主动脉夹层（AAAD）患者的临床表现及预后的性别差异。

方法

收集2009年1月至2014年7月间来自单一心脏中心的AAAD患者的临床资料。在进行倾向评分匹配后，比较AAAD患者中男性与女性在临床表现及预后方面的差异。

结果

通过对人口统计学和患者病史进行倾向评分匹配，纳入了590例AAAD患者（男性295例，女性295例）。我们发现，AAAD在女性中的表现及诊断往往延迟更久。女性更常出现充血性心力衰竭的严重体征（9.8%对5.1%，P = 0.017）、心脏压塞/休克（9.1%对4.1%，P < 0.001）以及主动脉周围血肿（26.4%对21.7%，P < 0.001）。男性接受手术的比例高于女性（95.4%（281/295）对91.5%（270/295），P = 0.045），表明性别与手术决策相关。为研究性别与术后预后的关系，对接受手术治疗的患者进行倾向评分再匹配（男性262例，女性262例）。女性的院内死亡率高于男性（8.4%对3.4%，P < 0.001）。女性术后充血性心力衰竭（9.1%对3.8%，P < 0.001）、内脏缺血（6.8%对1.1%，P < 0.001）和肢体缺血（7.6%对1.5%，P < 0.001）等并发症更为常见。对于女性而言，手术时间延长可能会增加院内死亡率，尤其是手术开始12小时后（30.0%对14.3%，P < 0.001）。Kaplan-Meier生存分析表明，匹配手术组中女性的远期预后更差（对数秩检验P = 0.012）。