Abstract
Objectives We aimed to investigate whether uncomplicated type A
intramural hematoma (IMHA) patients with type 2 diabetes mellitus (DM)
who underwent a “wait-and-watch strategy” and tight glycemic control
had similar clinical outcomes as patients without DM who received the
same treatment strategy. Methods Between January 2010 and December 2016,
uncomplicated IMHA patients with and without diabetes mellitus were
included and were propensity score matched to improve balance between
the two groups. Cox proportional hazard models were constructed to
identify the specific factors associated with aorta-related mortality.
The Fine-Gray model for the competing risk analysis was used to estimate
the aorta-related and non-aorta-related mortality in different groups
during the follow-up period. Results 109 IMHA patients were included in
this study, and 66 patients were included after matching. Patients
without DM experienced significantly more aorta-related adverse events
(51.6% vs 13.3%, P=0.001) and reinterventions than patients in the DM
group (29.0% vs 6.7%, P=0.023). Cox regression analysis revealed that
a higher matrix metalloproteinase-9 level (hazard ratio [HR], 1.70;
95% confidence interval [CI], 1.39-2.09, P<0.001) and
larger maximum aortic diameter (HR, 1.41; 95% CI, 1.11-1.80, P=0.005)
were associated with higher aorta-related mortality. The competing risk
analysis revealed a significantly higher aorta-related mortality during
the follow-up period in the no DM group than in the DM group (36.4%;
95% CI, 11.6%-82.3%, P=0.0294). Conclusions Uncomplicated IMHA
patients with DM (receiving the “wait-and-watch strategy” and tight
glycemic control) may have a lower aorta-related mortality, and rates of
aorta-related adverse events and reinterventions than the no DM group.