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. 2020 Jul 7;41(26):2430-2438.
doi: 10.1093/eurheartj/ehaa446.

Sex differences and temporal trends in aortic dissection: a population-based study of incidence, treatment strategies, and outcome in Swedish patients during 15 years

Christian Smedberg  1   2 , Johnny Steuer  1   2 , Karin Leander  3 , Rebecka Hultgren  4   5
Affiliations

Sex differences and temporal trends in aortic dissection: a population-based study of incidence, treatment strategies, and outcome in Swedish patients during 15 years

Christian Smedberg et al. Eur Heart J. .

Abstract

Aims: As large population-based studies of aortic dissection are lacking, the incidence numbers and knowledge about time-trends and sex differences are uncertain. The objective was to describe incidence, temporal trends and outcome of aortic dissection with particular emphasis on sex differences.

Methods and results: During the study period 2002-2016, 8057 patients in Sweden were diagnosed with aortic dissection, identified from the National Patient Register and the Cause of Death Register. A total of 5757 (71%) patients were hospitalized, whereas 2300 (29%) patients were deceased without concurrent hospital stay. The annual incidence was 7.2 per 100 000 (9.1 in men and 5.4 in women), decreasing over time in men (P = 0.005). Mean age in the hospitalized patients was 68 years (SD 13), 2080 (36%) were women. Within the first 14 days after onset, 1807 patients (32%) underwent surgical repair. The proportion of surgically treated increased from the 5-year period 2002-2006 to 2012-2016 [27% vs. 35%, odds ratio (OR) 1.61, 95% confidence interval (CI) 1.39-1.86; P < 0.001]. In hospitalized patients, 30-day mortality decreased between the same periods (26% vs. 21%, OR 0.68, 95% CI 0.59-0.80; P < 0.001). Long-term mortality decreased as well (hazard ratio 0.74, 95% CI 0.67-0.82; P < 0.001). Women had higher 30-day mortality than men after acute repair, a sex difference that remained after age adjustment (17% vs. 12%, OR 1.38, 95% CI 1.04-1.82; P = 0.006).

Conclusion: This population-based study detected a higher incidence of aortic dissection than prior reports, but a decreasing incidence in men. Surgical therapy was increasingly used and with more favourable outcome but was less frequently offered to elderly patients. The sustained sex differences regarding both incidence and outcome require further attention.

Keywords: Aortic dissection; Endovascular; Mortality; Population-based; Sex differences; Treatment.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Overview of all adult individuals with aortic dissection in Sweden 2002–2016 divided into different groups. Individuals identified from the Cause of Death Register are defined as deceased, not admitted. Aortic surgery is defined as acute the first 14 days and delayed after 14 days. Surgically treated patients are further divided into type A and type B dissections. Surgery for type B dissection is divided into open surgery and thoracic endovascular aortic repair.
Take home figure
Take home figure
This large population-based register study of over 8000 patients with aortic dissection demonstrates a higher incidence than earlier described, an increase in surgical management and improved outcome.
Figure 2
Figure 2
Incidence of aortic dissection in the adult population of Sweden (men and women) 2002–2016. 95% confidential intervals for each year are presented.
Figure 3
Figure 3
Proportions of admitted patients with aortic dissection treated with acute surgery of the aorta per year in total, in men and in women. 95% confidential intervals for each year are presented.
Figure 4
Figure 4
Thirty-day mortality in patients admitted with aortic dissection presented in total, in men and in women. 95% confidential intervals for each year are presented.
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