Dataset Information

Sex-Related Differences in Clinical Features and In-Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study.

ABSTRACT: Background The association between female sex and poor outcomes following surgery for type A acute aortic dissection has been reported; however, sex-related differences in clinical features and in-hospital outcomes of type B acute aortic dissection, including classic aortic dissection and intramural hematoma, remain to be elucidated. Methods and Results We studied 2372 patients with type B acute aortic dissection who were enrolled in the Tokyo Acute Aortic Super-Network Registry. There were fewer and older women than men (median age [interquartile range]: 76 years [66-84 years], n=695 versus 68 years [57-77 years], n=1677; P<0.001). Women presented to the aortic centers later than men. Women had a higher proportion of intramural hematoma (63.7% versus 53.7%, P<0.001), were medically managed more frequently (90.9% versus 86.3%, P=0.002), and had less end-organ malperfusion (2.4% versus 5.7%, P<0.001) and higher in-hospital mortality (5.3% versus 2.7%, P=0.002) than men. In multivariable analysis, age (per year, odds ratio [OR], 1.06 [95% CI, 1.03-1.08]; P<0.001), hyperlipidemia (OR, 2.09 [95% CI, 1.13-3.88]; P=0.019), painlessness (OR, 2.59 [95% CI, 1.14-5.89]; P=0.023), shock/hypotension (OR, 2.93 [95% CI, 1.21-7.11]; P=0.017), non-intramural hematoma (OR, 2.31 [95% CI, 1.32-4.05]; P=0.004), aortic rupture (OR, 26.6 [95% CI, 14.1-50.0]; P<0.001), and end-organ malperfusion (OR, 4.61 [95% CI, 2.11-10.1]; P<0.001) were associated with higher in-hospital mortality, but was not female sex (OR, 1.67 [95% CI, 0.96-2.91]; P=0.072). Conclusions Women affected with type B acute aortic dissection were older and had more intramural hematoma, a lower incidence of end-organ malperfusion, and higher in-hospital mortality than men. However, female sex was not associated with in-hospital mortality after multivariable adjustment.

SUBMITTER: Takahashi T

PROVIDER: S-EPMC9238608 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Sex-Related Differences in Clinical Features and In-Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study.

Takahashi Toshiyuki T Yoshino Hideaki H Akutsu Koichi K Shimokawa Tomoki T Ogino Hitoshi H Kunihara Takashi T Usui Michio M Watanabe Kazuhiro K Kawata Mitsuhiro M Masuhara Hiroshi H Yamasaki Manabu M Yamamoto Takeshi T Nagao Ken K Takayama Morimasa M

Journal of the American Heart Association 20220502 9

Background The association between female sex and poor outcomes following surgery for type A acute aortic dissection has been reported; however, sex-related differences in clinical features and in-hospital outcomes of type B acute aortic dissection, including classic aortic dissection and intramural hematoma, remain to be elucidated. Methods and Results We studied 2372 patients with type B acute aortic dissection who were enrolled in the Tokyo Acute Aortic Super-Network Registry. There were fewe ...[more]

PMID: 35492000

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Project description:BackgroundRecent reports on sex differences in long-term outcomes after surgery for acute type A aortic dissection (ATAAD) are conflicting. We aimed to aggregate updated data on long-term survival and reoperation stratified by sex.MethodsA literature search was conducted using Medline, Embase, and Cochrane Central. Studies reporting sex-stratified long-term survival and/or reoperation following surgery for ATAAD between January 1, 2000, to March 15, 2023 were included. Preoperative characteristics, intraoperative variables, and early perioperative outcomes were meta-analyzed using a random effects model and pooled risk ratio (RR) with men as the reference group. Individual patient-level data for long-term outcomes was reconstructed to generate sex-specific pooled Kaplan-Meier curves to assess long-term survival and freedom from reoperation.ResultsA total of 15 studies with 7,608 male and 3,989 female patients were included in this analysis. Female patients were older, had higher rates of hypertension, and had less previous cardiac surgery. Intraoperatively, women received less extensive repairs with lower rates of aortic valve replacement and total arch replacement, and higher rates of hemiarch replacement. There were no sex differences for in-hospital/30-day mortality [risk ratio (RR), 1.18; 95% confidence interval (CI): 0.96, 1.45; P=0.12], stroke (RR, 1.07; 95% CI: 0.90, 1.28; P=0.46), and early reoperation (RR, 0.90; 95% CI: 0.75, 1.09; P=0.28). Female patients had lower long-term survival overall (P<0.001) and amongst survivors at 1-year (P=0.014). Overall survival at 5-year was 82.4% in men and 78.1% in women, and at 10-year was 68.1% for men and 63.4% in women. Male patients had higher rates of long-term reoperation (P<0.001). Freedom for reoperation at 5-year was 88.4% in men vs. 93.1% in women.ConclusionsThough perioperative early outcomes have equalized between the sexes following surgery for ATAAD, differences remain in long-term survival and reoperation.

Project description:BackgroundOur goal was to create a prediction model for in-hospital death in Chinese patients with acute type A aortic dissection (ATAAD).MethodsA retrospective derivation cohort was made up of 340 patients with ATAAD from Tianjin, and the retrospective validation cohort was made up of 153 patients with ATAAD from Nanjing. For variable selection, we used least absolute shrinkage and selection operator analysis, and for risk scoring, we used logistic regression coefficients. We categorized the patients into low-, middle-, and high-risk groups and looked into the correlation with in-hospital fatalities. We established a risk classifier based on independent baseline data using a multivariable logistic model. The prediction performance was determined based on the receiver operating characteristic curve (ROC). Individualized clinical decision-making was conducted by weighing the net benefit in each patient by decision curve analysis (DCA).ResultsWe created a risk prediction model using risk scores weighted by five preoperatively chosen variables [AUC: 0.7039 (95% CI, 0.643-0.765)]: serum creatinine (Scr), D-dimer, white blood cell (WBC) count, coronary heart disease (CHD), and blood urea nitrogen (BUN). Following that, we categorized the cohort's patients as low-, intermediate-, and high-risk groups. The intermediate- and high-risk groups significantly increased hospital death rates compared to the low-risk group [adjusted OR: 3.973 (95% CI, 1.496-10.552), P < 0.01; 8.280 (95% CI, 3.054-22.448), P < 0.01, respectively). The risk score classifier exhibited better prediction ability than the triple-risk categories classifier [AUC: 0.7039 (95% CI, 0.6425-0.7652) vs. 0.6605 (95% CI, 0.6013-0.7197); P = 0.0022]. The DCA showed relatively good performance for the model in terms of clinical application if the threshold probability in the clinical decision was more than 10%.ConclusionA risk classifier is an effective strategy for predicting in-hospital death in patients with ATAAD, but it might be affected by the small number of participants.

Project description:ObjectivesThe association between preoperative D-dimer with morphologic features and surgical outcomes of acute type A aortic dissection is still unclear.Methods430 acute type A aortic dissection patients who underwent total arch replacement and frozen elephant trunk in Beijing Anzhen Hospital of Capital Medical University between January 2016 and December 2020 were enrolled in the present study. Patients were divided into higher D-dimer (>2307 ng/ml) group and lower D-dimer (≤2307 ng/ml) group. We compared the extent of dissection and branch artery perfusion patterns between the 2 groups. The restricted cubic spline was performed to assess the association between D-dimer with the extent of dissection and major adverse events after surgery.ResultsAmong 430 patients, there were 45 (10.47%) in-hospital mortality and 156 (36.28%) major adverse events. Patients with higher D-dimer had bigger dissection extension length and false lumen perimeter in ascending aorta, thoracic descending aorta, diaphragmatic, coeliac trunk and renal artery level. For the branch artery perfusion patterns, patients with higher D-dimer had a higher proportion of malperfusion among the innominate artery, right renal artery and both side iliac arteries, a higher proportion of dissected intercostal artery/all intercostal arteries >0.5 (43.46% vs 29.63%, P = 0.003). The restricted cubic spline linear regression model revealed a nonlinear association between lnD-dimer with extension length and false lumen perimeter (all P for overall and P for nonlinearity <0.001 except false lumen perimeter in ascending aorta level). The restricted cubic spline logistic regression model revealed a linear association between lnD-dimer with major adverse events (P for overall <0.001, P for nonlinearity = 0.637). The association between lnD-dimer and major adverse events was still significant in the fully adjusted logistic regression model with computed tomography angiography characteristics [odds ratio (95% confidence interval) =1.388 (1.137, 1.695), P = 0.001].ConclusionsPreoperative D-dimer strongly and positively correlates with the extent of dissection and major adverse events of acute type A aortic dissection after total arch replacement and frozen elephant trunk. D-dimer seems to be a supplement that indicates the severity of aortic dissection to aortic computed tomography angiography.

Dataset Information

Sex-Related Differences in Clinical Features and In-Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study.

Publications

Sex-Related Differences in Clinical Features and In-Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study.

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