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(Circulation. 2004;109:3014-3021.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Gender-Related Differences in Acute Aortic Dissection

Christoph A. Nienaber, MD^*; Rossella Fattori, MD^*; Rajendra H. Mehta, MD, MS; Barbara M. Richartz, MD; Arturo Evangelista, MD; Michael Petzsch, MD; Jeanna V. Cooper, MS; James L. Januzzi, MD; Hüseyin Ince, MD; Udo Sechtem, MD; Eduardo Bossone, MD; Jianming Fang, MD; Dean E. Smith, PhD; Eric M. Isselbacher, MD; Linda A. Pape, MD; Kim A. Eagle, MD, on Behalf of the International Registry of Acute Aortic Dissection

From the University Hospital Rostock (C.A.N., B.M.R., M.P., H.I.), Rostock School of Medicine, Rostock, Germany; University Hospital S. Orsola (R.F.), Bologna, Italy; University of Michigan (R.H.M., J.V.C., J.F., D.E.S., K.A.E.), Ann Arbor, Mich; Hospital General Universitari Vall d’Hebron (A.E.), Barcelona, Spain; Massachusetts General Hospital (J.L.J., E.M.I.), Boston, Mass; Robert-Bosch-Krankenhaus (U.S.), Stuttgart, Germany; National Research Council (E.B.), Southern Italy, Brindisi, Italy; and University of Massachusetts Hospital (L.A.P.), Worcester, Mass.

Correspondence to Christoph A. Nienaber, MD, FACC, Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany. E-mail christoph.nienaber{at}med.uni-rostock.de

Received June 24, 2003; de novo received October 20, 2003; revision received February 24, 2004; accepted March 4, 2004.

Background— Few data exist on gender-related differences in clinical presentation, diagnostic findings, management, and outcomes in acute aortic dissection (AAD).

Methods and Results— Accordingly, we evaluated 1078 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) to assess differences in clinical features, management, and in-hospital outcomes between men and women. Of the patients enrolled in IRAD (32.1%) with AAD, 346 were women. Although less frequently affected by AAD (32.1% of AAD), women were significantly older and had more often presented later than men (P=0.008); symptoms of coma/altered mental status were more common, whereas pulse deficit was less common. Diagnostic imaging suggestive of rupture, ie, periaortic hematoma, and pleural or pericardial effusion were more commonly observed in women. In-hospital complications of hypotension and tamponade occurred with greater frequency in women, resulting in higher in-hospital mortality compared with men. After adjustment for age and hypertension, women with aortic dissection die more frequently than men (OR, 1.4, P=0.04), predominantly in the 66- to 75-year age group. Moreover, surgical outcome was worse in women than men (P=0.013); type A dissection in women was associated with a higher surgical mortality of 32% versus 22% in men despite similar delay, surgical technique, and hemodynamics.

Conclusions— Our analysis provides insights into gender-related differences in AAD with regard to clinical characteristics, management, and outcomes; important diagnostic and therapeutic implications may help shed light on aortic dissection in women to improve their outcomes.

Key Words: aneurysm • aorta • registries • sex • imaging

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