Background: The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection (AAD) is needed. We aimed to investigate whether sex disparities are found in patients with AAD, and to study sex differences in complications, mortality in-hospital, and long-term.
Methods: We included 884 patients enrolled in our institute between June 2002 and May 2016. Considering psychosocial factors, treatments, and the outcomes in men versus those in women with AAD, we explored the association of sex with psychosocial characteristics and mortality risk. For categorical variables, significant differences between groups were assessed with the Chi-square test or Fisher's exact test, and continuous parameters were assessed with Student's t-test. Univariate and stratified survival statistics were computed using Kaplan-Meier analysis.
Results: A total of 884 patients (76.1% male, mean age 51.4 ± 11.8 years) were included in this study. There were fewer current smokers in female compared with male (17.5% vs. 67.2%, χ2 = 160.06, P < 0.05). The percentage of men who reported regular alcohol consumption was significantly higher than that in women (40.6% vs. 3.8%, χ2 = 100.18, P < 0.05). About 6.2% (55 of 884) of patients with AAD died before vascular or endovascular surgery was performed, 34.4% (304 of 884) of patients underwent surgical procedures, and 52.7% (466 of 884) and 12.8% (113 of 884) of patients received endovascular treatment and medication. Postoperative mortality similar (6.0% vs. 5.6%, respectively, χ2 = 0.03, P = 0.91) between men and women. Follow-up was completed in 653 of 829 patients (78.8%). Adjustment for age, history of coronary disease, hypertension, smoking and drinking, Type A and use of beta-blocker, angiotensin II receptor blockers, angiotensin converting enzyme (ACE) inhibitor, calcium-channel blockers and statins by multivariate logistic regression analysis suggested that age (odds ratios [OR s], 1.04; 95% confidence interval [CI], 1.01-1.07; P < 0.05), using of calcium-channel blockers (OR, 0.37; 95% CI, 0.18-0.74; P < 0.05), at discharge were independent predictors of late mortality, ACE inhibitors (OR, 1.91; 95% CI, 1.03-3.54; P = 0.04) was independent risk factor of late mortality.
Conclusions: In Chinese with AAD, sex is not independently associated with long-term clinical outcomes. Age, the intake of calcium-channel blockers at discharge might help to improve long-term outcomes.
中国人群急性主动脉夹层性别与预后的相关性研究摘要背景: 冠状动脉粥样硬化型疾病的发病率，临床表现，治疗措施及预后情况与性别相关。需要深入的了解主动脉夹层的性别差异。本研究旨在探索急性主动脉夹层的性别差异，研究不同性别的在院并发症及随访期间并发症及死亡的发生情况。 方法: 自2002年6月至2016年5月共入选884例急性主动脉夹层患者。登记发病特点、治疗方式及治疗效果，进而研究性别与发病特征、死亡风险的关联。计量资料以均数±标准差表示，正态分布资料的组间比较采用t检验。计数资料以率或百分数表示，组间比较应用χ2 检验或 Fisher精确概率法，随访期间死亡率用Kaplan-Meier生存曲线表示。 结果: 884例患者，其中男性76.1%（673），平均年龄（51.4 ± 11.8）岁。男性吸烟及饮酒的比例均明显高于女性(67.2% vs. 17.5%， χ2 =160.06，P<0.05；40.6% vs. 3.8%， χ2 =100.18，P<0.05)。计6.2%（55/884）患者术前死亡，34.4% (304/884) 患者行外科手术治疗，52.7% (466/884)患者行主动脉腔内修复术治疗， 12.8%(113/884)患者保守治疗。围术期死亡率两组无统计学差异 (6.0% vs. 5.6%， χ2 = 0.03，P = 0.91)。中位随访24个月，随访率为78.8%（653/829）。多因素回归分析显示：年龄(OR，1.04；P = 0.003)，钙离子拮抗剂的使用(OR, 0.37；P = 0.005)是长期预后的保护性因素, ACEI抑制剂的使用(OR，1.91；P = 0.040)是影响死亡的独立危险因素。 结论: 急性主动脉夹层的中国患者，性别不是影响长期预后的独立危险因素，年少及钙离子通道阻滞剂的使用可能是远期不良事件发生的保护性因素。.
Keywords: Aortic Dissection; Prognosis; Sex.