ArticleJournal of thoracic disease2026
Sex differences in pain presentation and its association with distal extent in acute type A aortic dissection: a retrospective cohort study.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute type A aortic dissection (ATAAD) is a life-threatening acute disease that requires swift diagnosis and surgical intervention. ATAAD patients typically present with acute stabbing chest pain and/or a tearing sensation between the shoulder blades. However, women have been reported to present more frequently with atypical symptoms, which is hypothesized to contribute to delayed diagnosis time and increased short-term mortality. This indicates that a more thorough insight into sex-differences in pain manifestation of ATAAD is required to improve diagnostic accuracy and shorten time to intervention reducing mortality, especially in women. This study investigated sex differences in pain manifestation in patients with ATAAD and their association with distal extent of dissection. Methods: We studied pain manifestation in a single-center cohort study of 460 ATAAD patients who underwent surgical treatment between 1992 and 2025 in the Leiden University Medical Center. Patients with incomplete symptom documentation (N=82) and diabetes mellitus (DM) (N=9) were excluded. Results: We found that chest pain is a strong indicator for ATAAD in both sexes. Women, however, present more often with non-specific back pain (P=0.053), dyspnea (P=0.003), and collapse (P=0.04). Men were found to have a further distal extent of dissection compared to women (P<0.001). Men more often presented with one prominent symptom, whereas women experienced a more diverse set of symptoms (P=0.006). Of note, patients with an ascending-contained dissection presented more frequently without any symptoms (P=0.005). Distal extent of dissection showed a significant association with increased likelihood of paraplegia (P<0.001) and abdominal pain (P=0.004), especially in men. Conclusions: Although chest pain remains a significant diagnostic hallmark of ATAAD, we showed significant sex-differences in pain manifestation of ATAAD. This study contributes to mounting evidence that there is sex-related difference in symptomatology in patients presented with ATAAD.
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