This is a retrospective study from double center: Xuzhou Central Hospital and The First People's Hospital of Yancheng. Acute myocardial infarction (AMI) were screened and AMI complicating with cardiogenic shock were included. This study is to investigate the relationship between red blood cell distribution width-to-albumin ratio (RAR) and major adverse cardiovascular events (MACEs) in acute myocardial infarction complicated with cardiogenic shock (AMI-CS) patients during hospitalization.

Coronary atherosclerotic heart disease is still the leading cause of death worldwide]. Studies show that the mortality and morbidity of acute myocardial infarction (AMI) in China are increasing year by year, which has brought significant burdens both in healthcare and economy of society. Although modified treatment and early reperfusion therapy can significantly reduce the mortality rate of patients with AMI, the in-hospital mortality rate still exceed over 4%. The high mortality in AMI is related to complications such as acute heart failure, malignant arrhythmia, cardiac rupture, and cardiogenic shock. Among them, cardiogenic shock is one of the most serious complications of AMI. Nearly 5% of patients with AMI develop cardiogenic shock during hospitalization. Moreover, the all-cause mortality of patients with cardiogenic shock significantly increases within 60 days, and the mortality rate of patients remain at high risk in long term.

Understanding the relevant factors and predictive indicators of AMI can provide valuable treatment strategies and prognosis information for clinicians, patients and their families. Current prognostic biomarkers have some limitations, such as high cost, long waiting time for test results and could not predicting outcomes accurately. Therefore, discovering a convenient and effective biomarker to predict the prognosis of acute myocardial infarction complicated with cardiogenic shock (AMI-CS) patients is very important. It could help us identify high-risk in these patients to potentially guide therapy strategy and patient management.

Red blood cell distribution width (RDW) is a biomarker reflecting the variation in red blood cell volume in human blood circulation. Previous studies have shown that an elevated RDW is closely associated with cardiovascular diseases, such as acute coronary syndromes, heart failure, etc. And it has emerged as a promising biomarker reflecting underlying inflammatory and oxidative stress processes in cardiovascular diseases. Previous studies shows that RDW was independently associated with an increased mortality rate in patients with AMI six months later and a long-term all-cause mortality rate increase in STEMI patients after revascularization. Recently, some recommendations have indicated that the combination of RDW with certain biomarkers may be more valuable for disease prognosis.

Albumin is a crucial protein in the human blood circulation system and is often used as a marker for nutritional status and overall health and it has been shown to be associated with reduction of oxidative stress and anti-inflammatory activity. And low serum albumin levels are associated with poor prognosis in cardiovascular diseases, which may indicate chronic inflammation and malnutrition. Recent studies have demonstrated that low albumin level is a significant predictor of poor prognosis in patients with AMI.

Given RDW and albumin have been individually linked to adverse cardiovascular outcomes, their combined marker, the red cell distribution width-to-albumin ratio (RAR), which has shown a potential prognostic value in AMI but not be fully explored. RAR may provide a more comprehensive assessment of AMI patient risks and help identify high-risk AMI patients who may benefit from more proactive intervention measures during hospitalization. Given the prognostic value of RAR on AMI-CS patients in short term is still unclear; this study is to investigate the relationship between RAR and major adverse cardiovascular events (MACEs) in AMI-CS patients during hospitalization.

Inclusion Criteria:

1. Age over 18 years and under 90 years;
2. Meeting the diagnostic criteria for acute myocardial infarction: myocardial injury markers (preferably troponin) ≥ 99th percentile of the upper limit of normal value, combined with at least one evidence of myocardial ischemia: persistent myocardial ischemic symptoms ≥ 30 minutes; accompanied by ST-segment elevation or depression on electrocardiogram;
3. Meeting the diagnostic criteria for cardiogenic shock: systolic blood pressure < 90 mmHg, accompanied by clinical symptoms of pulmonary congestion such as dyspnea, and at least one of the following peripheral organ perfusion impairments: altered mental status; cold and clammy skin; urine output < 30 ml/h; or serum lactate level > 2.0 mmol/L.

Exclusion Criteria:

1. Coexisting cerebrovascular disease, peripheral vascular disease or embolic disease;
2. Myocardial infarction caused by coronary artery embolism or blood flow interruption due to peripheral embolus detachment or invasive diagnostic and therapeutic procedures;
3. History of surgery, trauma or infection within one month;
4. History of severe liver or kidney dysfunction, , including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (γ-GGT) > 2.5 times upper limit of normal value; Serum creatinine > 1.5 times upper limit of normal value;
5. Coexisting autoimmune diseases, tumors, etc.

This is a retrospective study from double center: Xuzhou Central Hospital and The First People's Hospital of Yancheng. Between January 2019 and December 2024, a total of 3316 patients diagnosed with AMI were screened. Among them, 264 cases complicating with cardiogenic shock were included.