Baseline disease is more important predictor of intestinal necrosis than CT findings in patients with acute mesenteric ischemia

ABSTRACT Objective Acute mesenteric ischemia (AMI) is a potentially fatal vascular emergency and several computed tomography (CT) findings have been introduced to determine the presence of intestinal ischemia or necrosis although the most useful finding is unknown. Methods We retrospectively analyzed data of 43 consecutive patients with AMI who were treated during the period from 2006 to 2015. Study patients included both superior mesenteric artery dissection (SMAD, n = 29) and thrombosis (SMAT, n = 14). Epidemiological data, CT findings, and the primary endpoint defined as the composite of intestinal ischemia or necrosis based on surgical finding and in-hospital mortality were investigated. The classification and regression tree (CART) was used to assess determinants of the primary endpoint and area under the curve (AUC) of receiver operating characteristics was used to evaluate discriminating accuracy. Results In total, the primary endpoint occurred in 27.9% (0.0% in SMAD and 85.7% in SMAT). CART demonstrated the baseline disease was the only and strong determinant of the primary outcome (P < .001), which was also confirmed by the highest AUC of 0.968 (95% confidence interval 0.924–1.000). Conclusions The baseline disease rather than CT findings is the most important determinant of the primary endpoint. In patients with AMI, SMAT should undergo exploratory surgery and subsequent surgical treatment without delay.