Clinical outcomes and follow-up results after matching
In the DM group, ten patients received TEVAR treatment, including two
patients with ulcer-like projection development, seven patients with
type B aortic dissection development, and one patient with aortic
pseudoaneurysm. Two patients developed a type A aortic dissection in the
DM group and received open surgery; one patient died after the surgery
(Table 2 and Figure 3 ). In the no DM group, nine
patients with intramural hematoma evolution and unstable syndromes
underwent TEVAR (including one case of ulcer-like projection
development, seven cases of type B aortic dissection and one case of
aortic pseudoaneurysm, Figure 3 ). There were no statistically
significant different in the procedural details between the two groups,
and the stent was successfully deployed in all nineteen patients
(Table 2 ). The aorta-related mortality during the first
hospital stay was similar among two groups (9.1% vs 6.1%,P =1.000, Table 2 ). The indications and outcomes of
surgery/TEVAR are summarized in Figure 3. There were no
statistically significant differences in the procedural details between
the two groups (Table 2 ). All 61 patients survived the
in-hospital had follow-up after discharge. 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. The Fine-Gray model for the competing risk analysis revealed a
significantly higher aorta-related mortality during the follow-up period
in the no DM groups than in the DM group (36.4%; 95% CI,
11.6%-82.3%, P= 0.0294). The cumulative incidence curves for the
two groups were significantly different for aorta-related death
(P =0.0294) and not significantly different for non-aorta-related
death (P =0.567) (Figure 4A-C ). 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) (Figure 4D ). 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) (Table 2 ). 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(Supplement 2 ). During follow-up, eight
in ten deaths were caused by rupture of a retrograde type A aortic
dissection (n=5) and ascending aortic pseudoaneurysm (n=3) after
receiving TEVAR (Patients D -G , Supplement 3 ).