TY - JOUR
T1 - Male-female differences in acute thoracic aortic dissection
T2 - a systematic review and meta-analysis
AU - Meccanici, Frederike
AU - Gökalp, Arjen L
AU - Thijssen, Carlijn G E
AU - Mokhles, Mostafa M
AU - Bekkers, Jos A
AU - van Kimmenade, Roland
AU - Verhagen, Hence J
AU - Roos-Hesselink, Jolien W
AU - Takkenberg, Johanna J M
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - OBJECTIVES: This study aims to systematically review published literature on male-female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD).METHODS: A systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan-Meier curves.RESULTS: Nine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P < 0.001) and AD-B (P < 0.001), and in AD-A patients males had more distally extended dissections [OR 0.57, 95% confidence interval (CI) 0.46-0.70; P < 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17-0.41; P < 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58-0.72; P < 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84-1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83-1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male-female difference, whereas male patients had more reinterventions during follow-up.CONCLUSIONS: This systematic review shows male-female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male-female characteristics and outcomes are clearly warranted. Improved knowledge of male-female differences in AD will help shape optimal individualized care for both males and females.CLINICAL REGISTRATION NUMBER: PROSPERO, ID number: CRD42020155926.
AB - OBJECTIVES: This study aims to systematically review published literature on male-female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD).METHODS: A systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan-Meier curves.RESULTS: Nine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P < 0.001) and AD-B (P < 0.001), and in AD-A patients males had more distally extended dissections [OR 0.57, 95% confidence interval (CI) 0.46-0.70; P < 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17-0.41; P < 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58-0.72; P < 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84-1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83-1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male-female difference, whereas male patients had more reinterventions during follow-up.CONCLUSIONS: This systematic review shows male-female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male-female characteristics and outcomes are clearly warranted. Improved knowledge of male-female differences in AD will help shape optimal individualized care for both males and females.CLINICAL REGISTRATION NUMBER: PROSPERO, ID number: CRD42020155926.
KW - Acute aortic dissection
KW - Adult
KW - Aneurysm, Dissecting/diagnostic imaging
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Humans
KW - Male
KW - Prospective Studies
KW - Retrospective Studies
KW - Risk Factors
KW - Sex and gender
KW - Thoracic aorta
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85128160806&partnerID=8YFLogxK
U2 - 10.1093/icvts/ivab270
DO - 10.1093/icvts/ivab270
M3 - Review article
C2 - 34664071
SN - 1569-9285
VL - 34
SP - 616
EP - 627
JO - Interactive cardiovascular and thoracic surgery
JF - Interactive cardiovascular and thoracic surgery
IS - 4
ER -