Abstract
Objective To identify short-term prognostic factors in patients with acute myocardial infarction compli-cated by cardiogenic shock(AMI-CS)receiving venoarterial extracorporeal membrane oxygenation(V-A ECMO)support,and to develop an early risk prediction model to guide clinical decision-making and individualized management strategies.Methods A total of 112 AMI-CS patients who received V-A ECMO support at our center from January 2021 to December 2024 were retrospectively enrolled.Demographic data,laboratory findings,organ function scores,mechanical circulatory sup-port status,and clinical outcomes were collected.The primary endpoint was 28-day all-cause mortality.Univariate and mul-tivariate logistic regression analyses were performed to identify independent predictors of 28-day mortality.A composite risk prediction model was constructed and evaluated using receiver operating characteristic(ROC)curve analysis.Results Among the 112 patients enrolled,71.43%were male(80/112),and the mean age was 62.8±9.4 years.The 28-day mortality rate was 58.93%(66/112),and the successful weaning rate from ECMO was 41.07%(46/112).Compared with survivors,non-survivors had significantly higher baseline lactate levels(6.18±2.21 vs.4.03±1.65 mmol/L,P<0.001),serum creatinine(135.7±44.6 vs.104.2±38.1 μmol/L,P=0.002),NT-proBNP levels(15 836.3±7 642.5 vs.10 128.5±6 284.7 ng/L,P=0.009),and SOFA scores(10.6±3.1 vs.8.4±2.6,P<0.001),along with a lower rate of intra-aortic balloon pump(IABP)use(43.94%vs.67.39%,P=0.018).Multivariate logistic regression revealed that elevated lactate(OR=1.412,95%CI:1.136-1.755,P=0.002),higher NT-proBNP(OR=1.302,95%CI:1.071-1.684,P=0.003),increased SOFA score(OR=1.239,95%CI:1.045-1.470,P=0.014),and absence of IABP support(OR=2.231,95%CI:1.057-4.708,P=0.035)were independent predictors of 28-day mortality.ROC curve analysis demonstrated that lactate,NT-proBNP,and SOFA score yielded AUCs of 0.772,0.704,and 0.756,respective-ly.The combined prediction model showed improved discriminative performance,with an AUC of 0.842(95%CI:0.763-0.921),sensitivity of 85.5%,and specificity of 80.4%.Conclusion AMI-CS patients supported by V-A ECMO have a high short-term mortality.Baseline lactate,NT-proBNP,SOFA score,and IABP use are important prognostic indicators.A multifactorial predic-tion model based on these variables demonstrates good discriminatory power and may aid in early risk stratification and individu-alized clinical decision-making.关键词
静脉-动脉体外膜氧合/急性心肌梗死/心源性休克/预后分析Key words
veno-arterial extracorporeal membrane oxygenation/acute myocardial infarction/cardiogenic shock/prog-nostic analysis
