Abstract
Introduction: Acute mesenteric ischemia (AMI) is a life threatening emergency and is associated with many risk factors including atherosclerosis, hypertension, hypercoagulability, diabetes, smoking and obesity. We aimed to review demographic variations and predictors of mortality in patients with AMI. Methods: The Nationwide Inpatient Sample (NIS) was used to identify patients with a diagnosis of AMI during the years 2010-2014. Incidence of AMI and associated conditions were identified and a multivariate logistic regression analysis was done to determine predictors of mortality. Results: Of the 101,473 patients admitted with AMI, 80.5% of patients were White(mean age 68.5 year; p<0.05) compared to 8% African Americans(AA) (63 years; p<0.05) while 6.5% were Hispanics(65 years; p<0.05). Some comorbidities included diabetes mellitus(22% in Whites, 33% in AA, 31% in Hispanics; p<0.005), dyslipidemia(39% in Whites, 27% in AA, 32% in Hispanics; p<0.005), obesity(6% in Whites, 7% in AA, 8% in Hispanics; p<0.005). Regional variations showed 23.5% patients were White in the Northeast as compared to 2% AA(p<0.005) while 48% of patients were AA in the South as compared to 35% Whites(p<0.005). Similarly, the West had 38% Hispanics compared to 9% AA and 18% Whites(p<0.005). Overall mortality was 11.7%(p<0.005). This was slightly higher among AA(13.5%; p<0.05) compared to Whites(11%) and Hispanics(12%). It was seen that advancing age(OR 1.04; CI 1.04-1.05), diabetes mellitus(OR 1.28; CI 1.17-1.40), CKD(OR 1.71; CI 1.52-1.92), ESRD(OR 3.18; CI 2.70-3.76), hemodialysis status(OR 2.48; 1.90 - 3.20) and venous thromboembolism(OR 1.85; CI 1.28-2.70) were associated with greater mortality. Race and hypertension had no association with mortality. Surgical procedures like mesenteric bypass, arterectomy and embolectomy were associated with increased mortality. Among endovascular techniques, mesenteric angioplasty had no association while mesenteric stenting was associated with decreased mortality (OR 0.95; CI 0.126-0.139). Conclusion: Significant regional and ethnic variations exist in the prevalence of AMI which cannot be entirely explained by variations in predisposing comorbidities. Based on our study, it appears that endovascular revascularization is associated with reduced mortality whereas open surgical techniques are associated with increased mortality. This could be related to severity of AMI as well as underlying comorbidities leading to increased perioperative mortality.