Figure 3 Clinical Outcomes of Uncomplicated Type B Intramural
Hematoma after Matching
A total of 66 patients diagnosed with uncomplicated acute type A
intramural hematoma were included after matching. An ulcer-like
projection was defined as
an
intimal disruption with contrast material-filled pouching from the
aortic lumen and with a communicating orifice more than 3 mm in size
without atherosclerotic plaque. In the diabetes mellitus (DM) group, two
patients received surgery and ten patients underwent thoracic
endovascular aortic repair (TEVAR). The indications for surgery/TEVAR
were also summarized. In the DM group, during the acute phase
(<14 days), two patients died of sudden aortic rupture and one
patient who developed type A aortic dissection died of heart failure
after emergency open surgery. In the no DM group, two patients received
surgery and nine patients underwent TEVAR. Two patients died of sudden
aortic rupture during the subacute phase (15-90 days) of the first
hospitalization.
In the no DM group, two non-aorta-related death cases involved patients
who died of renal failure at 40 months and 39 months and the only
non-aorta-related death case in the DM group involved a patient who died
of lung cancer at 37 months. Only one patient with aorta-related death
was noted in the DM group and the nine aorta-related death deaths were
noted in the no DM group. In the no DM group, nine patients underwent
reintervention during the follow-up period including two cases of
surgical treatment (three cases of type A aortic dissection [AD])
and six cases of TEVAR, In the no DM group, the development of aortic
dissection was the most common reason for TEVAR/surgery reinterventions
(n=10) and the majority of aorta-related death cases (six patients)
occurred during the 3 to 6 months after the onset of intramural hematoma
(Figure 4D ). Five of these six patients (Patients 5, 6, 8, 9
and 10, Supplement 2 ) in the no DM group suffered from
chest/back pain after TEVAR during the subacute phase (14-90
days)(P <0.014) (Table 2 ) and died of
retrograde type A aortic dissection or ascending aortic pseudoaneurysm
rupture. During the follow-up, eight in ten death cases involved
patients who died of a ruptured retrograde type A aortic dissection
(n=5) or ascending aortic pseudoaneurysm (n=3) after receiving TEVAR
(Patients D -G , Supplement 3 ).
Figure 4Competing Risk Analysis
Results
A) The cumulative incidence of aorta-related and
non-aorta-related mortality in the diabetes mellitus (DM) group and no
DM group.
B-C) These two pictures show the results of Fine-Gray’s test
for equality of cumulative incidence functions across the DM and no DM
groups. In Picture B , the cumulative incidence curve for the
two groups was significantly different for aorta-related death
(P =0.0294). The no DM group had a significantly higher
aorta-related mortality during the follow-up period than the DM group
(36.4%; 95% confidence interval, 11.6%-82.3%, P= 0.0294).InPicture C, the cumulative incidence curve for the two groups is
not significantly different for non-aorta-related death
(P =0.567).
D) In the no DM group, more aorta-related deaths occurred
during the 3 to 6 months after the onset of intramural hematoma
(P =0.011). There were no significantly differences in the
aorta-related death among the DM and no DM groups at the other time
points. Although there was no significant difference in the acute phase,
all three death cases appeared during the acute phase (first 14 days
after the onset of uncomplicated type A intramural hematoma [IMH])
in the DM group. All 12 deaths in the no DM group appeared during the
first two years after the onset of uncomplicated type A IMH.