Takahashi Toshiyuki, Yoshino Hideaki, Shimokawa Tomoki, Ogino Hitoshi, Kunihara Takashi, Akutsu Koichi, Usui Michio, Yamasaki Manabu, Watanabe Kazuhiro, Kawata Mitsuhiro, Fujii Takeshiro, Masuhara Hiroshi, Takagi Tomomitsu, Imazuru Tomohiro, Yamamoto Takeshi, Nagao Ken, Kohsaka Shun, Takayama Morimasa
Tokyo CCU Network Scientific Committee, Tokyo, Japan.
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
JACC Adv. 2023 Oct 30;2(9):100661. doi: 10.1016/j.jacadv.2023.100661. eCollection 2023 Nov.
Sex differences in the clinical presentation and outcomes of DeBakey type I/II (Stanford type A) acute aortic dissection (AAD) remain unclear.
The authors aimed to determine the impact of sex on the clinical presentation and in-hospital outcomes of surgically or medically treated patients with type I/II AAD.
We studied 3,089 patients with type I/II AAD enrolled in multicenter Japanese registry between 2013 and 2018. The patients were divided into 2 treatment groups: surgical and medical. Multivariable logistic regression was used to examine the association between sex and in-hospital mortality.
In the entire cohort, women were older and more likely to have hyperlipidemia, previous stroke, altered consciousness, and shock/hypotension at presentation than men. Women had higher proportions of intramural hematomas and type II dissections than men. In the surgical group (n = 2,543), men had higher rates of preoperative end-organ malperfusion ( = 0.003) and in-hospital mortality ( = 0.002) than women. Multivariable analysis revealed that male sex was associated with higher in-hospital mortality after surgery (OR: 1.71; 95% CI: 1.24-2.35; < 0.001). In the medical group (n = 546), women were older and had higher rates of cardiac tamponade ( = 0.004) and in-hospital mortality ( = 0.039) than men; no significant association between sex and in-hospital mortality was found after multivariable adjustment (OR: 0.95; 95% CI: 0.56-1.59; = 0.832).
Male sex was associated with higher in-hospital mortality for type I/II AAD in the surgical group but not in the medical group. Further research is needed to understand the mechanisms responsible for worse surgical outcomes in men.
DeBakey I/II型（斯坦福A型）急性主动脉夹层（AAD）的临床表现和预后的性别差异仍不明确。
作者旨在确定性别对接受手术或药物治疗的I/II型AAD患者的临床表现和住院结局的影响。
我们研究了2013年至2018年纳入日本多中心登记处的3089例I/II型AAD患者。患者分为2个治疗组：手术组和药物治疗组。采用多变量逻辑回归分析来研究性别与住院死亡率之间的关联。
在整个队列中，女性比男性年龄更大，并且在就诊时更有可能患有高脂血症、既往中风、意识改变以及休克/低血压。女性壁内血肿和II型夹层的比例高于男性。在手术组（n = 2543）中，男性术前终末器官灌注不良（P = 0.003）和住院死亡率（P = 0.002）高于女性。多变量分析显示，男性性别与术后较高的住院死亡率相关（OR：1.71；95%CI：1.24 - 2.35；P < 0.001）。在药物治疗组（n = 546）中，女性比男性年龄更大，心包填塞发生率（P = 0.004）和住院死亡率（P = 0.039）更高；多变量调整后未发现性别与住院死亡率之间存在显著关联（OR：0.95；95%CI：0.56 - 1.59；P = 0.832）。
男性性别与手术组I/II型AAD的较高住院死亡率相关，但在药物治疗组中并非如此。需要进一步研究以了解导致男性手术结局较差的机制。
