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.

中文翻译：

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急性胸主动脉夹层的男女差异：系统评价和荟萃分析

目的 本研究旨在系统回顾已发表的关于诊断为急性胸主动脉夹层 (AD) 患者的表现、管理和结果方面的男女差异的文献。方法对 1999 年 1 月 1 日至 2020 年 10 月 19 日期间发表的研究进行系统文献检索，调查诊断为 AD 的成年患者的死亡率和发病率。将患者和治疗特征与优势比 (OR) 和标准化平均差进行比较，并使用随机效应模型对早期死亡率进行荟萃分析。通过合并的 Kaplan-Meier 曲线可视化总生存期和再手术。结果共纳入 9 项研究 A 型夹层 (AD-A)、1 项研究 B 型夹层 (AD-B) 和 3 项同时研究 AD-A 和 AD-B 的研究，共纳入 18 659 名患者。AD-A (P < 0.001) 和 AD-B (P < 0.001) 中的男性更年轻，并且在 AD-A 患者中，男性的远端夹层更多 [OR 0.57, 95% 置信区间 (CI) 0.46– 0.70; P＜0.001]。AD-A 中男性患者的手术时间更长（标准化均数差 0.29，95% CI 0.17–0.41；P < 0.001），而男性患者在 AD-B 中较少接受保守治疗（OR 0.65，95% CI 0.58– 0.72；P＜0.001)。AD-A 中男性与女性的合并早期死亡风险比为 0.94（95% CI 0.84–1.06，P = 0.308），AD-B 中为 0.92（95% CI 0.83–1.03，P = 0.143）。AD-A 的综合总死亡率没有显示男女差异，而男性患者在随访期间有更多的再干预。结论 该系统评价显示了 AD 患者和治疗特征的男女差异，可比较的早期和总体死亡率以及不一致的结果报告。由于已发表的文献稀少且异质性强，因此显然需要对男性-女性特征和结果进行标准化报告的大型前瞻性研究。提高对 AD 男女差异的了解将有助于为男性和女性提供最佳的个性化护理。临床注册号PROSPERO，身份证号：CRD42020155926。