Male–female differences in acute thoracic aortic dissection: a systematic
review and meta-analysis |
| |
| Authors: | Frederike Meccanici Arjen L Gkalp Carlijn G E Thijssen Mostafa M Mokhles Jos A Bekkers Roland van Kimmenade Hence J Verhagen Jolien W Roos-Hesselink Johanna J M Takkenberg |
| |
| Institution: | 1. Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands;2. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands;3. Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands ;4. Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands |
| |
| Abstract: | Open in a separate window OBJECTIVESThis study aims to systematically review published literature on male–female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD).METHODSA systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan–Meier curves.RESULTSNine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P < 0.001) and AD-B (P < 0.001), and in AD-A patients males had more distally extended dissections OR 0.57, 95% confidence interval (CI) 0.46–0.70; P < 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17–0.41; P < 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58–0.72; P < 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84–1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83–1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male–female difference, whereas male patients had more reinterventions during follow-up.CONCLUSIONSThis systematic review shows male–female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male–female characteristics and outcomes are clearly warranted. Improved knowledge of male–female differences in AD will help shape optimal individualized care for both males and females.Clinical registration numberPROSPERO, ID number: CRD42020155926. |
| |
| Keywords: | Thoracic aorta Acute aortic dissection Sex and gender |
|
|
