Clinical characteristics and prognosis of acute type B intramural hematoma among elderly patients

Abstract Background Intramural hematoma (IMH) within the aorta constitutes one of the acute aortic syndromes. Typically, individuals diagnosed with IMH tend to be of advanced age in comparison to those with aortic dissection (AD). The primary objective of this investigation was to gain insights into the prognosis of elderly patients suffering from type B IMH (TBIMH) and to ascertain the risk factors influencing their prognosis. Methods From January 2015 to October 2022, 71 consecutive elderly patients with TBIMH were admitted to the affiliated hospitals of China Medical University. Every patient in the cohort received their initial diagnosis of TBIMH. The basic information, initial imaging information, and survival outcomes of the patients were collected and analyzed. Results A total of 71 individuals (mean age 69.5 ± 6.6 years, 61% male) were included in this research. Among elderly patients with TBIMH, the 60–69 age group (33/71, 46.5%) was equivalent to patients in the 70 and older age group (38/71, 53.5%). The two groups exhibited no significant variation in terms of mid- and long-term survival. Kaplan–Meier survival curves suggested that alcoholism (P = 0.002), renal insufficiency (P = 0.031), presence of ulcer-like projections (ULPs; P = 0.039), and a maximum hematoma thickness of more than 13 mm (P = 0.026) were associated with aortic-related deaths. The Cox survival analysis demonstrated that a maximum hematoma thickness greater than 13 mm (HR = 3.782, 1.272–11.243; P = 0.017) was shown to significantly predict the progression of IMH. Conclusions In elderly patients with TBIMH, the presence of a hematoma exceeding 13 mm in thickness was identified as an independent risk factor for aortic-related mortality. Additionally, the coexistence of ULP and alcoholism appeared to be potentially correlated with an elevated risk of aortic-related mortality.