Gender Differences in Acute Type A Aortic Dissection: A Comprehensive Review and Meta-Analysis

He Jiao; Xiankun Liu; Yiming Bai; Lin Cong; Yunpeng Bai; Zhigang Guo

doi:10.1016/j.amjcard.2024.12.023

Gender Differences in Acute Type A Aortic Dissection: A Comprehensive Review and Meta-Analysis

Am J Cardiol. 2024 Dec 23:S0002-9149(24)00880-4. doi: 10.1016/j.amjcard.2024.12.023. Online ahead of print.

Authors

He Jiao¹, Xiankun Liu², Yiming Bai², Lin Cong¹, Yunpeng Bai³, Zhigang Guo⁴

Affiliations

¹ Medical School, Tianjin University, China; Department of Cardiac Surgery, Chest Hospital, Tianjin University, China.
² Department of Cardiac Surgery, Chest Hospital, Tianjin University, China.
³ Department of Cardiac Surgery, Chest Hospital, Tianjin University, China; Clinical school of Thoracic, Tianjin Medical University. Electronic address: oliverwhite@126.com.
⁴ Department of Cardiac Surgery, Chest Hospital, Tianjin University, China; Clinical school of Thoracic, Tianjin Medical University. Electronic address: zhigangguo2022@126.com.

PMID: 39722370
DOI: 10.1016/j.amjcard.2024.12.023

Abstract

Objective: To undertake a meta-analysis of cohort studies to evaluate sex-based differences for patients with acute type A aortic dissection (ATAAD).

Methods: A systematic search was performed across PubMed, Embase, and Cochrane Library (2000-2023) for studies reporting sex-related discrepancies in clinical presentation, and/or in-hospital management, and/or outcomes. Study effects were assessed utilizing mean difference or risk ratio (RR) as aggregated estimates. Besides, individual patient-level data on survival were reestablished to form sex-related Kaplan-Meier curves to evaluate long-term survival outcome. The study protocol was registered in PROSPERO (ID: CRD42024524125).

Results: The 21 studies were analyzed, comprising 6,728 females and 12,839 males. Females had lower risks of postoperative AKI (RR, 0.85; 95% CI, 0.72-1.00, P = 0.049) and reoperation (RR, 0.89; 95% CI, 0.81-0.99, P = 0.024), but a higher perioperative mortality (RR, 1.11; 95% CI, 1.03-1.18, P = 0.005) than males. Additionally, overall survival was poorer among females (P < 0.001), with 10-year survival rates of 66.5% for males and 60.0% for females.

Conclusion: In conclusion, ATAAD presents gender differences, with females facing higher perioperative and long-term mortality despite lower AKI and reoperation risks, suggesting a need for tailored management and prevention strategies.

Keywords: Acute type A aortic dissection; Gender; Meta-analysis.