Marume Kyohei, Noguchi Teruo, Kaichi Ryota, Yano Takao, Matsuyama Masakazu, Nagamine Yasuhiro, Mori Takayuki, Mikami Takafumi, Ikebe Sou, Takae Masafumi, Komaki Soichi, Ishii Masanobu, Toida Reiko, Kurogi Kazumasa, Inoue Yosuke, Matsuda Hitoshi, Murata Shunsuke, Nakaoku Yuriko, Ogata Soshiro, Nishimura Kunihiro, Nakashima Takahiro, Yamaguchi Tetsuro, Yamamoto Nobuyasu, Tsujita Kenichi
Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
JACC Adv. 2023 Oct 3;2(8):100623. doi: 10.1016/j.jacadv.2023.100623. eCollection 2023 Oct.
Acute aortic dissection (AAD) often leads to out-of-hospital cardiac arrest (OHCA) and death before hospital arrival.
The purpose of this study was to investigate differences in AAD incidence by sex.
A population-based study in a city with 121,180 residents was conducted using postmortem computed tomography data to identify patients with AAD who died before hospital arrival in 2008-2020. The incidence rate ratio and odds ratio were estimated using Poisson regression and univariable logistic regression, respectively.
A total of 266 patients with incident AAD were enrolled: 84 patients with OHCA, 137 women [n = 137], and 164 patients with type A AAD. The crude and age-adjusted incidence of AAD was 16.2 and 14.3/100,000 person-years, respectively. The incidence of AAD was comparable by sex (men, 16.7/100,000 person-years; women, 15.7/100,000 person-years; incidence rate ratio: 0.94; 95% CI: 0.74-1.20; = 0.64). Compared with men with AAD, women with AAD were older (77 ± 11 years vs 70 ± 14 years; < 0.001), and a higher proportion had type A AAD (76% vs 47%; < 0.001). Women with AAD had higher prehospital mortality than men with AAD (37% vs 21%; = 0.004; OR: 2.24; 95% CI: 1.30-3.87; = 0.004). Among 1,373 patients with OHCA, the proportion of women with AAD was significantly higher than the proportion of men with AAD (11% vs 3.9%; < 0.001; OR: 2.90; 95% CI: 1.86-4.53; < 0.001). AAD was most common in women aged 60 to 69 years (16.4%).
Women had a higher incidence of AAD presenting as prehospital death than men.
急性主动脉夹层（AAD）常导致院外心脏骤停（OHCA）并在到达医院前死亡。
本研究旨在调查AAD发病率的性别差异。
在一个有121,180名居民的城市进行了一项基于人群的研究，使用尸检计算机断层扫描数据来识别2008 - 2020年期间在到达医院前死亡的AAD患者。分别使用泊松回归和单变量逻辑回归估计发病率比和比值比。
共纳入266例新发AAD患者：84例OHCA患者，137例女性，164例A型AAD患者。AAD的粗发病率和年龄调整发病率分别为16.2/100,000人年和14.3/100,000人年。AAD发病率在性别上具有可比性（男性，16.7/100,000人年；女性，15.7/100,000人年；发病率比：0.94；95%置信区间：0.74 - 1.20；P = 0.64）。与患有AAD的男性相比，患有AAD的女性年龄更大（77 ± 11岁 vs 70 ± 14岁；P < 0.001），且A型AAD的比例更高（76% vs 47%；P < 0.001）。患有AAD的女性院外死亡率高于患有AAD的男性（37% vs 21%；P = 0.004；比值比：2.24；95%置信区间：1.30 - 3.87；P = 0.004）。在1373例OHCA患者中，患有AAD的女性比例显著高于患有AAD的男性比例（11% vs 3.9%；P < 0.001；比值比：2.90；95%置信区间：1.86 - 4.53；P < 0.001）。AAD在60至69岁女性中最为常见（16.4%）。
女性因AAD导致院外死亡的发病率高于男性。
