Background Available data about sex differences in patients with acute aortic dissection (AAD) are scant and conflicting. The aim of this study is to assess sex‐related differences in clinical characteristics, presentation, diagnostic findings, management, and outcomes among patients with type A (TA‐AAD) and type B AAD (TB‐AAD). Methods Data about 11 586 patients enrolled in the IRAD (International Registry of Acute Aortic Dissection) from 1996 to 2022, were analyzed; 7819 (67.5%) experienced TA‐AAD and 3867 (33.0%) TB‐AAD. Men and women were compared with regard to diagnosis, treatment, and in‐hospital and long‐term survival. Results One third of patients were women (TA‐AAD, 34.4%; and TB‐AAD, 34.5%). Women were older than men for both types of AAD. The median time from hospital admission to diagnosis was longer in women for both TA‐AAD and TB‐AAD ( P <0.001). For TA‐AAD, symptoms of hypotension and coma/altered mental status were more common in women, whereas for TB‐AAD women were more likely to present with congestive heart failure. Surgical repair for TA‐AAD was less frequent in women than men (84.6% versus 89.0%; P <0.001). For both types of AAD, medical management was more common among women than men (TA‐AAD, 16.5% versus 11.6%; P <0.001; TB‐AAD, 65.6% versus 54.2%; P <0.001). The overall as well as surgical in‐hospital mortality rate was higher among women with TA‐AAD compared with men ( P <0.001), whereas it was similar in those managed medically ( P =0.23). No difference in overall ( P =1), medical ( P =0.38), endovascular ( P =1), and surgical ( P =0.51) mortality rates was observed for TB‐AAD between men and women. After TA‐AAD, women showed lower 4‐year survival compared with men (81.4% versus 86.6%, P <0.001). Conclusions The present study highlights important sex‐related differences in AAD; there is a need to design tailored aortic disease management programs to improve outcomes in women.
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