Predictive value of different scoring models for survival rates in patients with acute myocardial infarction complicated with cardiogenic shock undergoing extracorporeal membrane oxygenation therapy

Feng Xiaoxin; Lu Andong; Wang Ting; Dong Kang; Bai Ming

doi:10.13498/j.cnki.chin.j.ecc.2024.06.05

Abstract：Objective This study aims to compare the predictive value of AMI-ECMO,ENCOURAGE,RESCUE,and SAVE scores in assessing the short-and mid-term survival rates of patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) who received veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support. Methods A retrospective analysis was conducted on patients admitted to the Cardiac Center of the First Hospital of Lanzhou University from January 2020 to June 2023,who had undergone direct percutaneous coronary intervention (PCI) and V-A ECMO support for AMI complicated with CS. We divided the patients into survival group and death group based on their clinical outcomes after ECMO implantation for 180 days. We collected and compared the clinical data of the two groups of patients,and the survival analysis was performed using the Kaplan-Meier and Log-rank test. By using the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) and the DeLong test,the predictive value of the four scoring systems for in-hospital,90-day,and 180-day mortality rates in this patient population was analyzed. Results A total of 128 patients were included. By the end of follow-up,68 patients died (53.1％),and 60 patients survived (46.8％). The survival group had lower ages,number of previous strokes,serum creatinine levels,lactate levels,AMI-ECMO scores,RESCUE scores,and ENCOURAGE scores compared to the mortality group (all P<0.05),while the SAVE score was higher in the survival group (P<0.05). Survival analysis showed that all four models could effectively stratify the risk of prognosis in this patient population (P<0.001). The ROC curves demonstrated that for predicting in-hospital mortality,90-day mortality,and 180-day mortality,the AUCs of the AMI-ECMO,ENCOURAGE,SAVE,and RESCUE scores were as follows:0.75,0.77,and 0.73;0.73,0.75,and 0.72;0.71,0.75,and 0.76;and 0.71,0.71,and 0.71,respectively (P>0.05). The SAVE score had the highest sensitivity in all timeframes (77.08％,75.81％,and 73.53％). When predicting in-hospital mortality,the ENCOURAGE score showed the highest specificity (83.75％);for 90-day and 180-day mortality,the AMI-ECMO score demonstrated the highest specificity (84.85％ and 85％). Conclusion This study suggests that the AMI-ECMO,RESCUE,ENCOURAGE,and SAVE scores can all be used as predictive methods for post-operative survival of patients with AMI complicated with CS who have received V-A ECMO treatment,and they can all provide effective prognostic risk stratification for patients. AMI-ECMO and ENCOURAGE scores have better predictive ability for short-term mortality,while the SAVE score has better predictive ability for medium-term mortality. The RESCUE score has generally moderate predictive ability.