Clinical characteristics and prognosis of aortic dissection in female patients: A retrospective study

OBJECTIVES: Fewer women have aortic dissection (AD) than men. This study was aimed to explore the clinical characteristics of AD in Chinese women. MATERIALS AND METHODS: Clinical manifestations, treatment methods, and prognosis of AD patients treated in the First Hospital of China Medical University from January 2010 to December 2019 were retrospectively analyzed. RESULTS: A total of 931 patients (240 female patients) were included in the study. The mean age was 53.48 ± 12.66 years. There was a smaller body mass index in female patients compared with male patients (25.23 ± 3.79 vs. 26.32 ± 4.04, P < 0.001). The percentages of women who reported regular cigarette and alcohol consumption were lower than those of men (8.7% vs. 36.3% and 7.2% vs. 22.1%, respectively, P < 0.001 for both). In terms of computed tomography (CT) imaging, the proportion of women with Type III arches was lower (11.3% vs. 26.0%, P < 0.001). The degree of AD tear in female patients was more limited than that in male patients. about 24.6% of female patients had AD in the superior arch branch, whereas 48.9% of male patients had AD in the iliac artery. Descending aortic branch involvement was less common in female patients (60.4% vs. 40.3%, P < 0.001), whereas AD occurred more frequently in the coeliac trunk in male patients (28.1% vs. 20.0%, P = 0.014). The level of false lumen thrombosis was higher in female patients compared with male patients at all levels of the aorta ( P < 0.001). In-hospital mortality was significantly higher in female patients with Type A AD than that in male patients (11.2% vs. 4.0%, P = 0.014), whereas stroke and myocardial ischemia were more common in female patients (8.8% vs. 4.6%, P = 0.018; 13.8% vs. 8.5%, P = 0.02). The all-cause and aorto-related mortality was lower in female patients (9.8% vs. 13.7%, P = 0.195; 5.8% vs. 11.4%, P = 0.034). However, there was no significant difference in the long-term survival rates between male and female patients ( P = 0.762). Cox regression analysis showed that hypertension, smoking, alcohol consumption, advanced age, and degree of AD tear were the risk factors affecting the long-term survival rate, whereas the false lumen thrombosis was the protective factor. CONCLUSION: Female patients had more stable clinical manifestations and slighter imaging changes in contrast-enhanced CT. Gender only had a certain impact on perioperative mortality but had no impact on long-term survival. These important clinical features and prognoses should be considered to improve clinical outcomes in female patients.