Women More Likely to Die From Aortic Dissection

Delay in diagnosis and treatment may be the primary reason, researchers report.

TUESDAY, June 15, 2004 (HealthDayNews) -- Although women are less likely to suffer from a life-threatening tear in the aortic wall called aortic dissection, they are more likely to die from it.

That's the conclusion of new German research that also found women don't seek medical help as rapidly as men do when aortic dissection occurs.

"We found that about two-thirds of the patients with aortic dissection who arrive at the hospital are men, and 30 percent were women," said lead author Dr. Christoph Nienaber, head of the cardiology division at University Hospital Rostock in Rostock, Germany. "This is basically the prevalence of the disease," he added.

"But the interesting, and unexpected, finding was that women present with chest pain later than men," Nienaber said. "For some reason, women don't react the same way to pain or they have a different perception of pain or they are not being taken care of by their husbands or live-ins," he commented.

Delayed diagnosis in women means more frequent death, Nienaber added. In addition, older women were more likely than men to refuse surgery, he said.

According to the American Heart Association, over 2,000 cases of aortic dissection are reported in the US each year. In a recent high-profile case, the actor John Ritter died suddenly last year after suffering an aortic tear.

Nienaber's team studied data from 732 men and 346 women enrolled in the International Registry of Acute Aortic Dissection, according to a report in the June 15 issue of Circulation.

According to the researchers, fewer women than men went for treatment within six hours of the start of symptoms, and a full 40 percent of women in the study waited more than 24 hours before seeking medical attention. The higher death rate for women with aortic dissection was especially true in the 66-75 age group.

In addition, they found that 32 percent of women who underwent surgery to repair the aortic tear died, compared with 22 percent of men.

Nienaber believes that doctors need to rethink the symptoms of aortic dissection. "Physicians need to realize that women have different and more diffuse symptoms than men do. And that's probably the major reason why the diagnosis is delayed," he said.

Aortic dissection causes immediate chest pain, according to the American Heart Association, and in almost two-thirds of the cases is linked to high blood pressure. But Nienaber said in women, other symptoms can include dizziness, shortness of breath, unconsciousness or stomach discomfort.

And he urged that "chest pain, irrespective of severity, needs to be clarified immediately. There is no reason to delay going to the emergency room or to your doctor."

Dr. Tyrone J. Krause, chief of thoracic and cardiothoracic surgery at UMDNJ-Robert Wood Johnson Medical School, took issue with some of the study's conclusions.

"I don't think the difference is gender-related. There is nothing specific about a woman that is more likely to make her die from an aortic dissection," he said.

In fact, he said, most patients who have an aortic dissection die when the dissection occurs.

"That's what happened to the actor John Ritter," he added.

"For those who actually get to the hospital alive, it comes down to the hospital making the diagnosis quick enough," Krause said. "Even then, another high percent will die even before they get operated on."

"It's hard to say that a delay in diagnosis causes a higher mortality rate," Krause said. "I wouldn't really put much stock in that."

More information

The American Heart Association can tell you more about aortic dissection.

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