静脉-动脉体外膜氧合治疗急性心肌梗死合并心源性休克患者的预后影响因素分析OA

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.