Abstract 17389: Sex Differences in Aortic Dissection Outcomes in the Houston Aortic Collaborative Experience

Abstract

Background: Data on sex-related differences in presentation, management, and clinical outcome in acute aortic dissection (AAD) are sparse, especially for acute type A (AAAD) and acute type B (ABAD) subtypes. Aims: To determine the effect of sex on AAD presentation, management and outcomes in a large cohort of patients from two major aortic surgery centers. Methods: We retrospectively reviewed the two-institution clinical data of all consecutive patients treated for AAD from 2000 to 2022. Data were analyzed by univariate and multivariable methods for short- and long-term data using SAS 9.4. Cox multivariable analyses were restricted to 3 years’ follow-up to avoid violating the proportional-hazards assumption. Results: Overall, 1,855 patients treated for AADs with 1,109 AAAD and 746 ABAD. Median age was 60 years (IQR:50-70); 620 (33%) were women. Women were older (64 vs 58 yrs; P<.001), had lower baseline renal function (36% vs 26%, p<.001) and more genetically triggered aortic disease (11% vs 7%, P=.002). Clinical presentation is shown in Table. Women had fewer renal (17% vs 24%; P=.001), bleeding (10% vs 14%; P=.01), and GI (22% vs 26%; P=.048) in-hospital complications. 30-day mortality was not different between groups (12% vs 14%; P=.271). There was no significant difference in mid or long-term survival by sex overall, however, stratified analysis showed lower survival for women with AAAD, notably in the first 3 years (Figure). Among AAAD cases, absolute risk difference attributable to COPD in stratified analysis was 17% in women (p<.01), but numbers are small (n=63). Multivariable risk factors for 3 year mortality were female (HR 1.3, p<.016), GFR<60 (HR 1.4, p<.003), rupture (HR 2.0, p<.001), CAD (HR 1.8, p<.001), mesenteric MPS (HR 2.1, p<.001). Conclusions: Women with AAD presented at an older age with poor baseline renal function and had higher prevalence of genetic disease and ABAD. 3-year adjusted survival for women with AAAD was worse than men; COPD may modify risk by sex.