title: Baseline disease is a 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 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: Department of Emergency Medicine, Hiroshima City Hospital, Hiroshima, Japan. Electronic address: toshihisa5143466@yahoo.co.jp.
authors: Toshihisa
authors: T
authors: Ichiba
authors: Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiovascular Medicine, Cloud Clinic, Takarazuka, Japan.
authors: Masahiko
authors: M
authors: Hara
authors: Department of Cardiovascular Surgery, Hiroshima City Hospital, Hiroshima, Japan.
authors: Keiji
authors: K
authors: Yunoki
authors: Department of Radiology, Hiroshima City Hospital, Hiroshima, Japan.
authors: Masaki
authors: M
authors: Urashima
authors: Department of Surgery, Hiroshima City Hospital, Hiroshima, Japan.
authors: Masao
authors: M
authors: Harano
authors: Department of Emergency Medicine, Hiroshima City Hospital, Hiroshima, Japan.
authors: Hiroshi
authors: H
authors: Naitou
authors: Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Kouji
authors: K
authors: Yamamoto
authors: Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Ayumi
authors: A
authors: Shintani
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D019540:Area Under Curve; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000209:etiology; D012372:ROC Curve; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D014057:Tomography, X-Ray Computed