Abstract 19445: Gender-Related Differences in Long-Term Outcomes of Hospital Survivors With Acute Type B Aortic Dissection
Introduction: While previous research has demonstrated that men and women differ in presentation and management of Type B aortic dissection (TBAD) in the acute phase, there is little data evaluating whether these differences persist post-discharge.
Methods: TBAD patients (N=2222) enrolled in The International Registry of Acute Aortic Dissection between January 1996 and February 2016 were stratified by male (N=1456, 65.5%) and female (N=766, 34.5%) gender. Of the patients that survived to discharge (N=2012 overall; 1318 (90.5%) men vs. 694 (90.6%) women, p=0.914), 724 men (54.9%) and 360 women (51.9%) had follow-up data available. Mean follow-up length was 2.8 years for men and 2.7 years for women (p=0.193).
Results: At the time of acute dissection, women were older (66.0±15.2 vs. 62.0±13.8, p<0.001) and had longer times from admission to diagnosis (3.3 (1.7-7.6) vs. 2.8 (1.3-5.9) hours, p=0.003). Surgical (12.4% vs. 8.4%, p=0.004) and endovascular treatment (26.4% vs. 20.2%, p=0.001) were more common in men; women were more likely to be medically managed (69.6% vs. 58.1%, p<0.001). Gender was not associated with a difference in mortality. At 1-year post-discharge, women were noted to have more frequent symptom recurrence (29.9% vs. 20.1%, p=0.002). Kaplan-Meier analyses of 5-year post-discharge mortality did not differ between groups, either overall or when stratified by baseline management type. Female gender was not an independent predictor of death on Cox Logistic Regression analysis (HR 1.09, 95% CI 0.63-1.87, p=0.762). Men demonstrated more follow-up aortic growth at 5 years, with 31.5% freedom from increased lumen diameter or aneurysm on Kaplan-Meier analysis versus 46.1% freedom in women (p=0.036). Furthermore, late intervention was more common in men, with 51.7% Kaplan-Meier freedom from late surgery or endovascular repair in men compared to 61.1% in women, (p=0.008).
Conclusion: Men were more likely to have aortic growth and surgical or endovascular intervention at 5 years post-discharge, indicating that a gender-based approach to follow-up may be useful. Kaplan-Meier analysis of 5-year morality was similar between men and women.
Author Disclosures: E. Bossone: None. S. Shalhub: None. H. Eckstein: None. E.A. Jackson: None. M.P. Bonaca: Research Grant; Significant; Amgen, AstraZeneca, Daiichi Sankyo Co Ltd, Eli Lilly and Co, GlaxoSmithKline, Merck and Co. Consultant/Advisory Board; Modest; Merck and Co., AstraZeneca, Bayer, and Roche diagnostics. M.P. Ehrlich: None. L.A. Pape: None. T. Suzuki: None. G.C. Hughes: None. A. Bhan: None. L.D. Conklin: None. D.G. Montgomery: None. A.C. Braverman: None. E.M. Isselbacher: None. K.A. Eagle: Research Grant; Modest; Medtronic, Terumo. Research Grant; Significant; W.L. Gore & Associates. C.A. Nienaber: None.
- © 2016 by American Heart Association, Inc.