Abstract
Objectives Investigating whether dipeptidyl peptidase-4 (DPP-4) inhibitors could influence clinical outcomes in intramural hematoma (IMH) patients with diabetes mellitus (DM). Methods IMH patients who received a "wait and watch strategy" were included. Cox proportional hazard models were constructed to identify potential risk factors. A Kaplan–Meier survival analysis was used to estimate all-cause and aorta-related mortality during the follow-up period. Results From January 2000 to December 2020, 1094 IMH patients were divided into group A (n=572, IMH patients without DM), group B (n=191, IMH patients with DM and receiving oral antidiabetic drugs [without admission of DDP-4 inhibitors]) and group C (n=331, IMH patients with DM and receiving oral antidiabetic drugs [including admission of DDP-4 inhibitors]). Group C had the lowest rate of aorta-related adverse events (6.4%), aorta-related mortality (1.2%) and reintervention (5.2%). Cox proportional hazard models revealed that lower eosinophil count (per 0.1, hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.51-0.73, P< 0.001) and thicker hematoma thickness (HR, 1.22; 95% CI, 1.06-1.39, P <0.001) were associated with higher occurrences of aorta-related adverse events. Lower eosinophil count (per 0.1, HR, 0.24; 95% CI, 0.15-0.40, P <0.001), larger descending aorta diameters (HR, 1.12; 95% CI, 1.02-1.23, P <0.021), and thicker hematoma thickness (HR, 3.25; 95% CI, 2.36-4.46, P <0.001) were also associated with increased aorta-related mortality. Kaplan-Meier survival analysis revealed a significant decrease in all-cause and aorta-related mortality in group C ( P <0.001). Conclusions DPP-4 administration influences progression of IMH patients with DM, leading to a lower rate of aorta-related adverse events, aorta-related mortality, and reinterventions.