Abstract
BACKGROUND: Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency with substantial early mortality. Whether diabetes mellitus (DM) independently influences short-term mortality in ATAAD remains uncertain. We conducted a meta-analysis to synthesize the available data. METHODS: PubMed, Embase, and Web of Science were searched from inception to June 22, 2025, for longitudinal studies reporting short-term mortality (in-hospital or 30-day) in ATAAD patients with and without DM. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model accounting for the influence of heterogeneity. Subgroup, sensitivity, and meta-regression analyses explored heterogeneity. The study quality was assessed with the Newcastle-Ottawa Scale (NOS). RESULTS: Twenty-one retrospective cohort studies involving 19,291 patients were included. DM was associated with a modestly increased short-term mortality risk (OR = 1.48; 95% CI 1.14 to 1.91; p = 0.003; I(2) = 44%). The results were consistent in sensitivity analyses restricted to surgical patients (OR = 1.52; 95% CI 1.18 to 1.96; p = 0.001). Subgroup analyses showed no significant differences by region, follow-up duration, analytic model, or NOS score (all p for subgroup differences > 0.05). Meta-regression analysis showed that sample size was negatively correlated with the association (coefficient = - 0.000074, p = 0.02), which fully explained the source of heterogeneity (adjusted R(2) = 100%). CONCLUSIONS: This meta-analysis of retrospective studies suggests that DM may be associated with higher short-term mortality in ATAAD. Given the observational nature of the evidence, further prospective studies are needed to clarify this relationship.