Objectives We aimed to summarize the clinical presentations, 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 or not they had DM. Cox proportional hazard analysis was utilized to investigate the risk factors for aortic-related mortality. Kaplan-Meier survival analysis was used to estimate cumulative mortality and aortic-related mortality. Results A total of 149 patients were included and were divided into the two groups (DM group [n=60] and non-DM group [n=89]). Patients in the non-DM group underwent thoracic endovascular aortic repair treatment more frequently (12% vs 2%, P=0.028) and had a higher reintervention rate during the follow-up (9 in 81 patients, 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) levels (HR, 1.92; 95% CI, 1.51-2.49, P<0.001) and MMP-9 levels (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 levels are associated with an elevated risk for aorta-related mortality.

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.

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.