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Abstract：
BACKGROUND: Acute mesenteric ischemia is rare, and few large-scale trials have evaluated endovascular therapy (EVT) and open surgical revascularization (OS). This study aimed to assess clinical outcomes after EVT or OS for acute superior mesenteric artery occlusion and identify predictors of mortality and bowel resection.
RESULTS: Data from the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database from April 2012 to March 2020 were retrospectively analyzed. Overall, 746 patients with acute superior mesenteric artery occlusion who underwent revascularization were classified into 2 groups: EVT (n=475) or OS (n=271). The primary clinical outcome was in-hospital mortality. The secondary outcomes were bowel resection, bleeding complications (transfusion or endoscopic hemostasis), major adverse cardiovascular events, hospitalization duration, and cost. The in-hospital death or bowel resection rate was ≈30%. In-hospital mortality (22.5% versus 21.4%, P=0.72), bowel resection (8.2% versus 8.5%, P=0.90), and major adverse cardiovascular events (11.6% versus 9.2%, P=0.32) were comparable between the EVT and OS groups. Hospitalization duration in the EVT group was 6 days shorter than that in the OS group, and total hospitalization cost was 0.88 million yen lower. Interaction analyses revealed that EVT and OS had no significant difference in terms of in-hospital death in patients with thromboembolic and atherothrombotic characteristics. Advanced age, decreased activities of daily living, chronic kidney disease, and old myocardial infarction were significant predictive factors for in-hospital mortality. Diabetes was a predictor of bowel resection after revascularization.
CONCLUSIONS: EVT was comparable to OS in terms of clinical outcomes in patients with acute superior mesenteric artery occlusion. Some predictive factors for mortality or bowel resection were obtained.
BACKGROUND: URL: www.umin.ac.jp/ctr/; Unique Identifier: UMIN000045240.
RESULTS: Data from the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database from April 2012 to March 2020 were retrospectively analyzed. Overall, 746 patients with acute superior mesenteric artery occlusion who underwent revascularization were classified into 2 groups: EVT (n=475) or OS (n=271). The primary clinical outcome was in-hospital mortality. The secondary outcomes were bowel resection, bleeding complications (transfusion or endoscopic hemostasis), major adverse cardiovascular events, hospitalization duration, and cost. The in-hospital death or bowel resection rate was ≈30%. In-hospital mortality (22.5% versus 21.4%, P=0.72), bowel resection (8.2% versus 8.5%, P=0.90), and major adverse cardiovascular events (11.6% versus 9.2%, P=0.32) were comparable between the EVT and OS groups. Hospitalization duration in the EVT group was 6 days shorter than that in the OS group, and total hospitalization cost was 0.88 million yen lower. Interaction analyses revealed that EVT and OS had no significant difference in terms of in-hospital death in patients with thromboembolic and atherothrombotic characteristics. Advanced age, decreased activities of daily living, chronic kidney disease, and old myocardial infarction were significant predictive factors for in-hospital mortality. Diabetes was a predictor of bowel resection after revascularization.
CONCLUSIONS: EVT was comparable to OS in terms of clinical outcomes in patients with acute superior mesenteric artery occlusion. Some predictive factors for mortality or bowel resection were obtained.
BACKGROUND: URL: www.umin.ac.jp/ctr/; Unique Identifier: UMIN000045240.
摘要：
背景：急性肠系膜缺血很少见，很少有大规模试验评估血管内治疗(EVT)和开放手术血运重建(OS).本研究旨在评估急性肠系膜上动脉闭塞的EVT或OS后的临床结果，并确定死亡率和肠切除的预测因素。
结果：回顾性分析了2012年4月至2020年3月日本所有心脏和血管疾病注册-诊断程序组合（JROAD-DPC）数据库中的数据。总的来说,将746例急性肠系膜上动脉闭塞患者进行血运重建，分为两组：EVT（n=475）或OS（n=271）。主要临床结局是院内死亡率。次要结果是肠切除术，出血并发症（输血或内镜止血），主要不良心血管事件，住院时间，和成本。院内死亡或肠切除率约为30％。住院死亡率（22.5%对21.4%，P=0.72),肠切除术（8.2%对8.5%，P=0.90),和主要不良心血管事件(11.6%对9.2%，P=0.32）在EVT和OS组之间具有可比性。EVT组的住院时间比OS组短6天,住院总费用减少了88万日元。相互作用分析显示，在具有血栓栓塞和动脉粥样硬化特征的患者中，EVT和OS在院内死亡方面没有显着差异。高龄,日常生活活动减少，慢性肾病,和陈旧性心肌梗死是院内死亡率的重要预测因素.糖尿病是血管重建术后肠切除的预测因子。
结论：在急性肠系膜上动脉闭塞患者的临床结局方面，EVT与OS相当。获得了一些死亡率或肠切除的预测因素。
背景：URL：www.乌明。AC.jp/ctr/;唯一标识符:UMIN000045240。
结果：回顾性分析了2012年4月至2020年3月日本所有心脏和血管疾病注册-诊断程序组合（JROAD-DPC）数据库中的数据。总的来说,将746例急性肠系膜上动脉闭塞患者进行血运重建，分为两组：EVT（n=475）或OS（n=271）。主要临床结局是院内死亡率。次要结果是肠切除术，出血并发症（输血或内镜止血），主要不良心血管事件，住院时间，和成本。院内死亡或肠切除率约为30％。住院死亡率（22.5%对21.4%，P=0.72),肠切除术（8.2%对8.5%，P=0.90),和主要不良心血管事件(11.6%对9.2%，P=0.32）在EVT和OS组之间具有可比性。EVT组的住院时间比OS组短6天,住院总费用减少了88万日元。相互作用分析显示，在具有血栓栓塞和动脉粥样硬化特征的患者中，EVT和OS在院内死亡方面没有显着差异。高龄,日常生活活动减少，慢性肾病,和陈旧性心肌梗死是院内死亡率的重要预测因素.糖尿病是血管重建术后肠切除的预测因子。
结论：在急性肠系膜上动脉闭塞患者的临床结局方面，EVT与OS相当。获得了一些死亡率或肠切除的预测因素。
背景：URL：www.乌明。AC.jp/ctr/;唯一标识符:UMIN000045240。
