Acute Aortic Dissection More Deadly in Women Than in Men

Women with aortic dissection are more likely than men to die of the condition, possibly as a result of later recognition of the disease, according to a report in the June 22nd issue of Circulation.

There are 2000 new cases of acute aortic dissection each year in the U.S. and 3000 new cases in Europe, the authors explain, but few data exist on possible gender-related differences in this highly lethal condition and its management and outcomes.

Dr. Christoph A. Nienaber from Rostock School of Medicine, Germany and colleagues participating in the International Registry of Acute Aortic Dissection evaluated differences between 1078 patients (732 men and 346 women) presenting with acute aortic dissection from 1996 through 2001.

Similar proportions of men and women were diagnosed within 4 hours of symptom onset, the authors report, but significantly more women were diagnosed after 24 hours of symptoms.

Women were less likely than men to present with abrupt onset of pain, the report indicates, and more likely to present with congestive heart failure and coma/altered mental status.

Moreover, diagnostic findings suggestive of severe clinical/anatomic presentation or impending rupture were more frequent among women, the researchers note, whereas lack of false lumen thrombosis was more frequent among men.

A higher percentage of women than men were managed medically, the investigators report, but even among patients managed surgically, mortality was substantially higher among women (31.9%) than among men (21.9%). Mortality differences were especially notable among patients in the high-risk group (41.9% for women, 30.9% for men) and in the 66- to 75-year age group (36% for women, 16% for men).

Women had a 40% higher death rate than men, even after adjustment for age, type of dissection, and history of hypertension, the results indicate.

“Thus, there are various reasons that may all interfere with a clear-cut early suspicion of dissection in women, leading to later presentation and eventually to later diagnosis of life-threatening dissection in women,” Dr. Nienaber told Reuters Health. “This chain of events may finally end up in later treatment with an impact on prognosis and outcome.”

“There is a need to educate doctors and the public (especially women) that the symptoms of acute aortic syndrome (aortic dissection and its precursors) may not be as typical as described in textbooks or as is the common perception,” Dr. Nienaber said. “Chest pain of any kind (even untypical presentation and not so severe) in so-called risk groups (for coronary disease and for aortic disease) needs to be taken seriously and should undergo swift evaluation, often by tomographic imaging.”

Circulation 2004;109:3014-3021.