Abstract Rationale Acute mesenteric ischemia (AMI) is a highly lethal vascular emergency that can rapidly progress to multiorgan failure. Atrial fibrillation (AF) is a known cause of embolic mesenteric ischemia and has been linked to increased mortality, but its impact on other markers of severe disease—particularly the need for mechanical ventilation—remains unclear. Since intubation often reflects systemic decompensation, evaluating whether AF increases ventilation risk may improve risk stratification and guide early management. Methods We conducted a retrospective cohort study using the National Inpatient Sample (2017-2022). Adult patients (≥18 years) with a principal diagnosis of AMI were identified using ICD-10-CM codes. The primary outcome was the requirement for mechanical ventilation. Predictor variables included AF, demographics, and comorbidity burden as measured by the Charlson Comorbidity Index (CCI). Analyses were performed in Stata 19, applying HCUP sampling weights to generate nationally representative estimates. Multivariate survey-weighted logistic regression was used to identify independent predictors of intubation. Results Among 92,675 AMI hospitalizations, 5.9% (n = 5,435) required mechanical ventilation. AF was independently associated with increased odds of ventilation (aOR 1.84, 95% CI 1.48-2.28, p 0.001). Higher comorbidity burden also significantly increased risk (CCI category 3: aOR 3.48, 95% CI 2.67-4.53, p 0.001). Racial disparities were observed: African American (aOR 1.84, 95% CI 1.48-2.28, p 0.001) and Native American patients (aOR 2.87, 95% CI 1.38-5.95, p = 0.005) had greater odds compared to White patients. Conclusions In this nationwide analysis, AF, comorbidity burden, and racial disparities were significant predictors of mechanical ventilation in AMI. AF may not only precipitate AMI but also serve as a marker of systemic deterioration requiring advanced organ support. These findings underscore the importance of early hemodynamic optimization and vigilant critical care monitoring in AMI patients with AF. This abstract is funded by: None
Cho et al. (Fri,) studied this question.
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