ArticleFrontiers in cardiovascular medicine2026
Low-flow time and neurological outcomes in AMI patients undergoing ECPR: a retrospective cohort study.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute myocardial infarction (AMI) complicated by refractory cardiac arrest (CA) carries extremely high mortality and neurological disability rates. Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue intervention for this population, but outcomes after its use vary widely across individuals. Low-flow time (the interval from initiation of chest compressions to establishment of stable ECMO flow) is an important prognostic factor among ECPR-treated patients. Its association with outcomes in Chinese patients with AMI-related CA remains incompletely characterized. Methods: We conducted a retrospective cohort study of 161 eligible adult patients with AMI-related refractory CA who received ECPR at our tertiary center between January 2019 and December 2025. The primary endpoint was 30-day unfavorable neurological outcome [Cerebral Performance Category (CPC) score 3-5]. Multivariable logistic regression evaluated low-flow time continuously as the primary exposure. RCS regression assessed possible nonlinearity, whereas ROC analysis provided a secondary, exploratory cohort-specific classification. We performed an exact-timing sensitivity analysis and a full-cohort interaction analysis to assess heterogeneity by arrest setting. Results: Among the 161 enrolled patients, 118 (73.3%) had 30-day unfavorable neurological outcomes, including 104 deaths (64.6%). After multivariable adjustment, each additional minute of low-flow time was associated with higher odds of unfavorable outcome (aOR 1.065, 95% CI 1.036-1.096; Conclusions: Among selected AMI patients who received ECPR, increasing low-flow time was progressively associated with unfavorable 30-day neurological outcome, with no detected nonlinear inflection or evidence of effect modification by arrest setting. These findings are prognostic among ECPR-treated patients and do not define when ECPR should or should not be initiated. The internally derived 50.9-min classification is exploratory and is not an eligibility threshold.
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