Abstract 283: Diabetes and Dissection: An Analysis from the International Registry of Acute Aortic Dissection

Abstract

Background: Studies have shown that diabetes is less prevalent in acute aortic dissection (AAD) or aortic aneurysm patients (pts) than it is in those with coronary artery disease or heart failure. While diabetes has been found to inhibit aortic aneurysm development in laboratory animals, little is known about its impact on AAD. Methods: Of 3,662 pts enrolled in the International Registry of Acute Aortic Dissection, 248 (6.8%) were diabetic. Diabetic and non-diabetic pts with type A (TA) (n=2371, 6.2% diabetic) and type B (TB) (n=1291, 7.9% diabetic) AAD were compared in this study. Results: Diabetic pts were on average older than non-diabetic for both TA (67.7 vs 61.4 years, p<0.001) and TB (67.8 vs 63.2 years, p<0.001). Pts with TA AAD and diabetes were more often managed medically (18.5%, 27/287 vs 11.7%, 260/2225, p=0.015), while TB diabetic pts were more likely to undergo endovascular procedures (29.4%, 30/102 vs 20.8%, 247/1189, p=0.045). TA diabetics had more in-hospital myocardial infarction (12.9%, 18/139 vs 6.8% 143/2099, p=0.007). Both TA and TB diabetics had more acute renal failure in hospital (TA: 34.3%, 48/140 vs 24.4% 513/2105, p=0.009; TB: 27.7% 28/101 vs 16.8%, 188/1118, p =0.006). In-hospital mortality was similar between groups. TB diabetics had significantly higher follow-up mortality on Kaplan-Meier analysis (p=0.028). Conclusion: Diabetes does not appear to impact treatment selection or in-hospital mortality for pts with AAD. However, it is important to note that diabetic pts demonstrate lower rates of follow-up survival, a trend that reaches significance in type B pts. The lower prevalence of diabetes among IRAD pts compared to other cardiovascular diseases suggests that diabetes may impact the development of AAD.