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.