The impact of race and ethnicity on the clinical presentation and outcomes of acute type a aortic dissection

Abstract Background/Introduction An acute type A aortic dissection (ATAAD) is among the most intricate and potentially fatal conditions affecting the cardiovascular system. Despite some literature on variations in the presentation and outcomes of aortopathy across different racial and ethnic groups, significant gaps remain in understanding how racial and ethnic factors influence ATAAD outcomes. Purpose This study investigates the trends in clinical presentation, post-operative complications, and mortality rates across different racial groups. Methods This study analyzed retrospectively obtained data of ATAAD patients at two university medical centers from 2000 to 2023. Data on patient characteristics, characteristics at presentation and clinical outcomes were compared. Data analysis involved stratifying by racial groups, applying statistical tests, and using a logistic regression model to assess 30-day mortality, adjusting for age, sex, and socioeconomic status. Results Our study included 615 ATAAD patients from five racial groups: White (87.5%), Asian/Pacific Islander (4.6%), Middle Eastern/North African (2.6%), Black (2.1%), and Hispanic (1.3%). Significant differences were observed in age at presentation, with White patients being oldest (62.9 ± 12.2 years) and Middle Eastern/North African patients youngest (50.0 ± 12.3 years, p = 0.002). Middle Eastern/North African and Black patients had higher rates of prior myocardial infarction (18.8% p=0.024). The ethnic majority, European white patients, had higher rates of new-onset post-operative atrial fibrillation (33.1% vs. 19.5%; p=0.016), while ethnic minority patients had higher rates of pre-operative hypertension (66.2% vs. 49.2%; p=0.006). No significant variations in re-intervention or mortality rates were found. Conclusion This study highlights significant racial and ethnic differences in the clinical presentation and outcomes of ATAAD. The fundamental causes of these disparities require more international collaborative investigations with larger cohorts. A personalized approach to risk stratify and treat patients based on their race and ethnicity could help reduce cardiovascular risk disease burden among ethnic minorities.Graphical Abstract