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World J Gastrointest Surg. Aug 27, 2026; 18(8): 118103
Published online Aug 27, 2026. doi: 10.4240/wjgs.118103
Long-term outcomes following successful treatment of acute mesenteric ischemic event: A population-based observational study
Karri Kase, Merli Koitmäe, Annika Reintam Blaser, Kadri Tamme, Peep Talving, Marko Murruste
Karri Kase, Marko Murruste, Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
Karri Kase, Annika Reintam Blaser, Kadri Tamme, Peep Talving, Marko Murruste, Institute of Clinical Medicine, University of Tartu, Tartu 50090, Estonia
Merli Koitmäe, Institute of Mathematics and Statistics, University of Tartu, Tartu 50090, Estonia
Merli Koitmäe, Institute of Genomics, University of Tartu, Tartu 50090, Estonia
Annika Reintam Blaser, Centre of Intensive Care Medicine, Luzerner Kantonsspital, Lucerne 6000, Luzern, Switzerland
Kadri Tamme, Department of Anesthesiology and Intensive Care, Tartu University Hospital, Tartu 50406, Estonia
Peep Talving, Department of Surgery, North Estonia Medical Centre, Tallinn 13419, Estonia
Author contributions: Kase K drafted the manuscript; Koitmäe M performed the statistical analysis; Reintam Blaser A, Tamme K, Talving P, and Murruste M assisted with writing the manuscript; Kase K, Koitmäe M, Reintam Blaser A, Tamme K, Talving P, and Murruste M conceptualized the study; and all authors critically revised the manuscript and approved its final version.
Supported by the Estonian Research Council, No. PRG1255.
Institutional review board statement: Ethical approval for the study was obtained from the Estonian Committee on Bioethics and Human Research (No. 1.1-12/2736).
Informed consent statement: The Ethics Committee gave approval to do the study without consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: Study data can be made available upon reasonable request for future collaborative analyses.
Corresponding author: Karri Kase, MD, Lecturer, Department of Surgery, Tartu University Hospital, Puusepa 8, Tartu 50406, Estonia.
karri.kase@kliinikum.ee
Received: December 25, 2025
Revised: February 6, 2026
Accepted: April 10, 2026
Published online: August 27, 2026
Processing time: 235 Days and 1.4 Hours
BACKGROUND
There is a lack of studies reporting long-term outcomes in patients surviving initial event of acute mesenteric ischemia (AMI).
AIM
To identify population-based outcomes and risk factors for mortality according to AMI subtypes.
METHODS
We performed overall survival analysis of all enrolled AMI patients and follow-up investigation on patients who survived beyond index admission. The demographics, diagnostic and management variables, in addition to causes of death, were accrued from the Estonian National Electronic Health Database and medical records between 2016 and 2024. Risk factors for mortality were analyzed using univariable and multivariable analyses for all AMI patients and separately for patients with superior mesenteric artery thrombosis. Survival curves were calculated using Kaplan–Meier estimators.
RESULTS
In total, 572 patients were analyzed for overall survival. There were 203 patients discharged alive after an AMI event, with a median age of 74 years (range 64–80 years) and a median follow-up time of 39 months (interquartile range 10–63 months). Overall 3-year and estimated 5-year survival was 19.2% and 15.6%, while 3-year and estimated 5-year survival of the discharged patients was 54.2% and 44.2%, respectively. Survival curves for all patients diverged between AMI subtypes, with improved survival in patients with superior mesenteric vein occlusion. The 3-year and estimated 5-year survival curves of discharged patients did not differ between the subtypes of AMI, however, the estimated 8-year survival curves showed improved survival in patients with nonocclusive mesenteric ischemia and superior mesenteric vein occlusion. The main cause of death after discharge (44.3%) was another cardiovascular event. Multivariable analysis including all discharged patients, revealed advanced age, disability, and high Charlson’s comorbidity index as significant risk factors and antithrombotic therapy as protective factors for mortality.
CONCLUSION
Risk factors for mortality for all patients were advanced age, disability, comorbidity, and lack of antithrombotic therapy. In superior mesenteric artery thrombosis, post-discharge antithrombotic therapy was associated with improved long-term survival, but this requires prospective validation, and optimal antithrombotic strategies still necessitate individualized evaluation.
Core Tip: We observed overall improved survival for patients with superior mesenteric vein occlusion; however, for patients discharged alive, survival rates were higher in the case of nonocclusive mesenteric ischemia and superior mesenteric vein occlusion. The risk factors for mortality in all patients included age, disability, comorbidity, and lack of antithrombotic therapy. Our data suggest long-term survival benefit in patients with superior mesenteric artery thrombosis, who receive antithrombotic therapy following discharge. Future prospective studies should assess different regimens of antithrombotic therapy.
