Disease Progression, Treatment and Follow-up
During the acute phase, the occurrence rate of disease progression (20 of 89 cases) was higher in the non-DM group than in the DM group (22% vs 7%, P =0.011), and disease progression occurred obviously earlier than in the non-DM group than in the DM group (6.4±1.3 vs 12.0±1.4 days, P <0.001). Among these twenty cases, the most common sign of disease progression was signs of aortic rupture (eight cases), followed by the development of ULPs (seven cases) and aortic dissection development (two cases) (Figure 2B ). The occurrence rates of ULPs development (7% vs 0%, P =0.042) and signs of aortic rupture (9% vs 0%, P =0.022) were significantly higher in the non-DM group, while the incidence of other disease progressions signs was similar between the two groups (Table 2 ). Compared to those in the DM group, more patients in the non-DM group received TEVAR treatment during the acute phase (12% vs 2%,P =0.028). The two death cases after TEVAR treatment in the non-DM group include one patient died of retrograde type A aortic dissection and one patient died of aortic rupture (Figure 2B and Figure 3 ).
The aorta-related mortality in patients with IMHB are also summarized inTable 2 and Figure 4. There were significantly differences in the aorta-related death among the DM and non-DM groups during the acute phase (<14 days) (0 vs 8 cases,P =0.042) (Figure 4A ). The non-DM group also had a higher reintervention rate during follow-up than the DM group (9 in 81 cases, 11% vs 2%, P =0.043). Additionally, the non-DM group had a higher probability of hematoma worsening (22% vs 5%, P =0.004) and a higher rate of aorta-related mortality during the follow-up period (11% vs 2%, P =0.043) than the DM group (Table 2 ).
The Cox regression analysis revealed that ULP development (during the acute phase) (HR, 1.07; 95% CI, 1.01-1.31, P=0.008), 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 (Table 3 ). The Kaplan-Meier survival analysis revealed a significant increase in the aortic-related mortality rate of the DM group compared with that of the non-DM group (P =0.0023, Figure 4B ).