A linear association between serum uric acid and 28-day and 90-day mortality after veno-arterial extracorporeal membrane oxygenation in patients with acute myocardial infarction complicated by cardiogenic shock.

Objective: This study aimed to delineate the relationship between serum uric acid (UA) and 28-day and 90-day mortality among patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: In this retrospective, single-center cohort study, we consecutively enrolled 142 patients supported with VA-ECMO for AMI-CS. Baseline UA was treated as the exposure of interest, and 28-day and 90-day mortality were prespecified primary outcomes. Associations between UA and mortality were evaluated using Cox proportional-hazards models, Kaplan-Meier estimates, receiver operating characteristic curve (ROC), and restricted cubic spline (RCS) regression. Results: Among 142 patients, the median baseline UA level was 452.00 μmol/L (361.00-561.75 μmol/L), and 28-day and 90-day mortality were 33.8% and 40.8%, respectively. After adjustment for potential confounders, each 1 μmol/L increment in UA remained associated with higher hazards of 28-day mortality (HR: 1.002, 95% CI: 1.000-1.003; Conclusions: Elevated UA was associated with increased 28-day and 90-day mortality after VA-ECMO in AMI-CS. Given the single-center, retrospective, and observational design, these findings should be interpreted cautiously and require external validation before UA can be considered for clinical risk assessment.