Outcomes of Uncomplicated Type B Intramural Hematoma Patients with Type
2 Diabetes Mellitus
Abstract
Objectives We aimed to summarize the clinical presentation, therapeutic
approaches, and outcomes of type B intramural hematoma (IMHB) patients
with and without type 2 diabetes mellitus (DM). Methods Patients with
uncomplicated IMHBs were included between January 2016 and January 2018
and divided into two groups according to whether they had DM or not. Cox
proportional hazard analysis was utilized to investigate the risk
factors of aortic-related mortality. Kaplan-Meier survival analysis with
the log-rank test was used to estimate the cumulative mortality and
aortic-related mortality. Results 149 patients were included and were
divided into to two groups (DM group [n=60] and non-DM group
[n=89]). Patients in the non-DM group underwent thoracic
endovascular aortic repair (TEVAR) treatment more frequently (12% vs
2%, P=0.028) and had a higher reintervention rate during the follow-up
(9 in 81 cases, 11% vs 2%, P=0.043). There were significant
differences between the two groups regarding the aorta-related mortality
rate during the acute phase (9% vs 0%, P=0.042) and the all-cause
mortality rate (22% vs 7%, P=0.011). Ulcer-like projection (ULP)
development (during the acute phase) (hazard ratio [HR], 1.07; 95%
confidence interval [CI], 1.01-1.31, P=0.008), C-reactive protein
(CRP) level (HR, 1.92; 95% CI, 1.51-2.49, P<0.001) and MMP-9
level (HR, 16.82; 95% CI, 7.52-28.71, P<0.001) were
associated with an elevated risk for aorta-related mortality.
Conclusions IMHBs without DM are not benign and have a considerably high
aortic-related mortality rate. ULP development (during the acute phase),
CRP levels and maximum MMP-9 are associated with an elevated risk for
aorta-related mortality.