Prognostic factors after acute mesenteric ischemia: which patients require specific management?

Purpose Diagnosis and treatment of AMI are a real issue for implicating physicians. In the literature, only one AMI stroke center has reported its results so far, with increasing survival rates. Our aim was to analyze acute mesenteric ischemia (AMI) related mortality and predictive factors, in a single academic center, before creating a dedicated intestinal stroke center. Methods All the patients with an AMI, between January 2015 and December 2020, were retrospectively included. They were divided into 2 groups according to the early mortality: death during the first 30 days and alive. The 2 groups were compared. Results 173 patients (57% of men), were included, with a mean age of 68 ± 16 years. Overall mortality rate was 61%. Mortality occurred within the first 30 days in 78% of dead cases. Dead patients were significantly older, more frequently admitted from intensive care, with more serious clinical, laboratory and radiological characteristics. We have identified 3 protective factors - history of abdominal surgery (Odd Ratio = 0.1; 95%CI = 0.01–0.8, p = 0.03), medical management with curative anticoagulation (OR = 0.09; 95%CI = 0.02–0.5, p = 0.004) and/or antiplatelets (OR = 0.04; 95%CI = 0.006–0.3, p = 0.001)-, and 2 predictive factors of mortality – age > 70 years (OR = 7; 95%CI = 1.4–37, p = 0.02) and previous history of coronaropathy (OR = 13; 95%CI = 1.7–93, p = 0.01). Conclusions AMI is a severe disease with high morbidity and mortality rates. Even if its diagnosis is still difficult because of non-specific presentation, its therapeutic management needs to be changed in order to improve survival rates, particularly in patients older than 70 years with history of coronaropathy. Developing a dedicated organization would improve the diagnosis and the management of patients with AMI.