Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands.
Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
Interact Cardiovasc Thorac Surg. 2022 Mar 31;34(4):616-627. doi: 10.1093/icvts/ivab270.
This study aims to systematically review published literature on male-female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD).
A systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan-Meier curves.
Nine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P < 0.001) and AD-B (P < 0.001), and in AD-A patients males had more distally extended dissections [OR 0.57, 95% confidence interval (CI) 0.46-0.70; P < 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17-0.41; P < 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58-0.72; P < 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84-1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83-1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male-female difference, whereas male patients had more reinterventions during follow-up.
This systematic review shows male-female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male-female characteristics and outcomes are clearly warranted. Improved knowledge of male-female differences in AD will help shape optimal individualized care for both males and females.
PROSPERO, ID number: CRD42020155926.
本研究旨在系统回顾已发表的文献，以探讨男性和女性在急性胸主动脉夹层（AD）患者临床表现、治疗和结局方面的差异。
对 1999 年 1 月 1 日至 2020 年 10 月 19 日期间发表的研究进行系统文献检索，以调查成年 AD 患者的死亡率和发病率。使用比值比（OR）和标准化均数差值比较患者和治疗特征，并采用随机效应模型进行早期死亡率的荟萃分析。使用合并的 Kaplan-Meier 曲线直观显示总生存率和再次手术率。
共纳入 9 项研究（其中 1 项研究 AD-A，1 项研究 AD-B，3 项研究 AD-A 和 AD-B），纳入 18659 例患者。AD-A 患者中男性更年轻（均 P<0.001），AD-B 患者中男性也更年轻（均 P<0.001），AD-A 患者中男性的夹层更向远端延伸[OR 0.57，95%置信区间（CI）0.46-0.70；P<0.001]。AD-A 中男性的手术时间更长（标准化均数差值 0.29，95%CI 0.17-0.41；P<0.001），而 AD-B 中男性接受保守治疗的比例较低（OR 0.65，95%CI 0.58-0.72；P<0.001）。AD-A 中男性与女性的早期死亡率风险比为 0.94（95%CI 0.84-1.06，P=0.308），AD-B 中为 0.92（95%CI 0.83-1.03，P=0.143）。AD-A 中的总生存率无性别差异，但男性患者在随访期间有更多的再次干预。
本系统综述表明，AD 患者的性别存在差异，治疗特征也存在差异，早期和总体死亡率相当，结果报告不一致。由于现有文献较少且存在异质性，因此显然需要开展大型前瞻性研究，对男性和女性的特征和结局进行标准化报告。对 AD 中男女差异的深入了解将有助于为男性和女性提供最佳个体化治疗。
PROSPERO，注册号：CRD42020155926。
