Abstract
<jats:p>Acute myocardial infarction (AMI) complicated by cardiogenic shock is associated with high in-hospital mortality despite early revascularization and the use of mechanical circulatory support. Lactate is a marker of tissue hypoperfusion; however, its absolute value may not adequately reflect the effectiveness of therapy.The aim of this study was to evaluate the prognostic significance of early lactate dynamics in patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Materials and methods. A single-center retrospective cohort study included 57 patients with AMI and cardiogenic shock who underwent PCI with VA-ECMO support between 2021 and 2025. Lactate levels were measured before ECMO initiation (T0), and at 6 (T6) and 24 (T24) hours. Lactate clearance was calculated as a percentage. The primary endpoint was in-hospital mortality. Multivariable logistic regression analysis was performed to determine independent prognostic predictors.Results. In-hospital mortality was 36.8 %. Baseline lactate level (T0) did not differ between survivors and non-survivors (p=0.381). At 24 hours, lactate levels were significantly lower in survivors (p=0.032). Lactate clearance at 6 and 24 hours was significantly higher in survivors (p=0.013 and p=0.001, respectively). In multivariable analysis, 24-hour lactate clearance remained an independent predictor of in-hospital mortality (OR 0.71 per each 10 % increase; 95 % CI 0.55–0.93; p=0.013). According to ROC analysis, 24-hour lactate clearance demonstrated a moderate predictive ability for in-hospital mortality (AUC = 0.60). The optimal cutoff value for lactate clearance was approximately 72 %, with a sensitivity of 85.7 % and a specificity of 38.9 % for predicting mortality.Conclusions. In patients with AMI complicated by cardiogenic shock undergoing PCI with VA-ECMO support, early lactate dynamics – particularly 24-hour lactate clearance – has independent prognostic value for in-hospital mortality. Serial lactate monitoring may serve as an effective tool for early risk stratification and optimization of therapeutic strategy.</jats:p>