Sex-related differences in early morphological and clinical outcomes in patients with type A intramural hematoma: an observational cohort study

Objectives: To investigate sex-based differences in presenting characteristics and early outcomes of type A intramural haematoma.

Methods: Patients with type A intramural haematoma in an institutional cohort were consecutively enrolled between December 2013 and July 2022. Presenting characteristics, morphological progression and all-cause death during hospitalisation were evaluated according to sex.

Results: Among 473 patients, 48.0% were female. Females were older (65.9 ± 9.1 vs 58.5 ± 11.5 years, P < 0.001) with larger ascending aortic diameters (52.2 ± 6.6 vs 48.3 ± 6.1 mm, P < 0.001), thicker hematomas (11.5 ± 4.9 vs 9.5 ± 3.4 mm, P < 0.001), and more frequent focal intimal disruptions (45.4% vs 29.7%, P < 0.001). Within 30 days of initial medical therapy, 89.8% of males vs 70.1% of females showed morphological regression or stable condition on repeat CTA. The in-hospital mortality was 9.7% in females (n = 22) and 2.8% in males (n = 7). Kaplan-Meier analysis revealed higher early mortality in females (P = 0.002). Multivariable Cox regression showed female sex as an independent risk factor for early death (HR: 2.8, 95% CI: 1.2-6.8, P = 0.021). Subgroup analysis revealed no heterogeneity according to subgroups including older age (71-90 years), ascending aortic diameter ≥ 50 mm, presence of focal intimal disruption, presence of pericardial effusion, haematoma thickness ≥ 11 mm, and hypertension.

Conclusions: Female patients with type A intramural haematoma presented with worse characteristics, higher early morphological progression, and an increased risk of early death compared to males.