Women may have different symptoms and are more likely to die after acute aortic dissection than men, a new study finds.
Up to 40% of patients die instantly from this spontaneous tear in one of the body’s main arteries, and the risk of death increases about 1% for every hour of delay in diagnosis and surgery, according to the findings published online June 2 in The Annals of Thoracic Surgery journal.
“It has been known for a long time that outcomes after aortic dissection are dependent on time to treatment: The faster a person is treated the better,” Dr. Benjamin Youdelman, of Maimonides Medical Center in New York City, said in a journal news release. He was not involved in the research.
Aortic dissections are divided into two groups (A and B), according to the location of the tear. In type A, the tear begins where the aorta exits the heart. It becomes deadly when it migrates toward the heart and ruptures into the pericardial sac that surrounds it.
In this study, researchers analyzed data on more than 2,800 patients who were treated for type A aortic dissection between 1995 and 2018. About 34% were women.
Compared to male patients, female patients were older (average 65.4 years versus 58.6), and had different symptoms such as low blood pressure and a greater evidence of malperfusion (loss of blood supply to a vital organ). Women more often went into shock (31.3% versus 22.2%) or had coma/altered consciousness (11.5% versus 7.5%). They also were more likely to die.
“Data over the course of the last few decades demonstrate differences in both presentation and outcomes between males and females who have acute aortic dissection, with greater mortality among females,” said study author Dr. Thomas Gleason, a cardiac surgeon at Brigham and Women’s Hospital in Boston.
“This study underscores the need for further interrogatories into these sex differences that may help provoke refined sex-directed strategies to further improve outcomes,” he said in the release.
The gender differences in presenting symptoms suggest that women may wait longer to seek care, resulting in a higher percentage who are in shock or experiencing changes in mental status that are often attributed to stroke.
This may further delay the correct diagnosis, Youdelman said.
“All of this results in worse early outcomes after aortic dissection for women compared to men,” he added.
The Society for Vascular Surgery has more on aortic dissection.
SOURCE: The Annals of Thoracic Surgery, news release, June 2, 2021