Toshihisa Ichiba1, Masahiko Hara2, Keiji Yunoki3, Masaki Urashima4, Masao Harano5, Hiroshi Naitou6, Kouji Yamamoto7, Ayumi Shintani7. 1. Department of Emergency Medicine, Hiroshima City Hospital, Hiroshima, Japan. Electronic address: toshihisa5143466@yahoo.co.jp. 2. Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiovascular Medicine, Cloud Clinic, Takarazuka, Japan. 3. Department of Cardiovascular Surgery, Hiroshima City Hospital, Hiroshima, Japan. 4. Department of Radiology, Hiroshima City Hospital, Hiroshima, Japan. 5. Department of Surgery, Hiroshima City Hospital, Hiroshima, Japan. 6. Department of Emergency Medicine, Hiroshima City Hospital, Hiroshima, Japan. 7. Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan.
Abstract
OBJECTIVE: Acute mesenteric ischemia (AMI) is a potentially fatal vascular emergency, and several computed tomographic (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 (n = 29) and thrombosis (SMAT, n = 14). Epidemiological data, CT findings, and the primary end point defined as the composite of intestinal ischemia or necrosis based on surgical finding and in-hospital mortality were investigated. The classification and regression tree was used to assess determinants of the primary end point, and area under the curve of receiver operating characteristics was used to evaluate discriminating accuracy. RESULTS: In total, the primary end point occurred in 27.9% (0.0% in superior mesenteric artery dissection and 85.7% in SMAT). Classification and regression tree demonstrated that the baseline disease was the only and strong determinant of the primary outcome (P< .001), which was also confirmed by the highest area under the curve 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 end point. In patients with AMI, SMAT should undergo exploratory surgery and subsequent surgical treatment without delay.
OBJECTIVE: Acute mesenteric ischemia (AMI) is a potentially fatal vascular emergency, and several computed tomographic (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 (n = 29) and thrombosis (SMAT, n = 14). Epidemiological data, CT findings, and the primary end point defined as the composite of intestinal ischemia or necrosis based on surgical finding and in-hospital mortality were investigated. The classification and regression tree was used to assess determinants of the primary end point, and area under the curve of receiver operating characteristics was used to evaluate discriminating accuracy. RESULTS: In total, the primary end point occurred in 27.9% (0.0% in superior mesenteric artery dissection and 85.7% in SMAT). Classification and regression tree demonstrated that the baseline disease was the only and strong determinant of the primary outcome (P< .001), which was also confirmed by the highest area under the curve 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 end point. In patients with AMI, SMAT should undergo exploratory surgery and subsequent surgical treatment without delay.
Authors: Alfonso Canfora; Antonio Ferronetti; Gianpaolo Marte; Vittorio Di Maio; Claudio Mauriello; Pietro Maida; Vincenzo Bottino; Giovanni Aprea; Bruno Amato Journal: Open Med (Wars) Date: 2019-12-17