Prognostic value of the atherogenic index of plasma combined with lactate-to-albumin ratio for in-hospital mortality in patients with acute myocardial infarction complicated by cardiogenic shock

Background Acute myocardial infarction complicated by cardiogenic shock (AMICS) carries high in-hospital mortality. We evaluated the combined prognostic value of the Atherogenic Index of Plasma (AIP), reflecting lipid metabolism, and the Lactate-to-Albumin Ratio (LAR), reflecting tissue hypoperfusion and inflammation, in AMICS. Methods This retrospective cohort included 207 consecutive patients with AMICS between January 2023 and January 2025, classified as survivors ( n = 174) or non-survivors ( n = 33). Admission clinical, laboratory, echocardiographic, and treatment variables were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression selected candidate predictors; multivariable logistic regression identified independent predictors and generated a nomogram. Performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration metrics, bootstrap internal validation, and decision curve analysis. Results Non-survivors had higher AIP (0.33 ± 0.23 vs. 0.06 ± 0.30) and LAR than survivors ( P < 0.05). LASSO identified six candidate predictors. Mechanical ventilation (OR = 10.10, 95% CI: 3.09–33.09, P < 0.001), LVEF <40% (OR = 3.49, 95% CI: 1.23–9.90, P = 0.019), AIP (OR = 4.30 per SD increase, P < 0.001), and LAR (OR = 1.88 per SD increase, P = 0.005) were independently associated with in-hospital mortality. The combined model showed good-to-excellent internal discrimination (AUC = 0.909, bootstrap 95% CI: 0.853–0.957), exceeding AIP (AUC = 0.777) or LAR (AUC = 0.735) alone. Calibration was acceptable (Hosmer–Lemeshow P = 0.853; Brier score = 0.077, bootstrap 95% CI: 0.052–0.103). The model underwent internal validation only and should be considered hypothesis-generating pending external validation. Conclusion AIP and LAR were independently associated with in-hospital mortality and may reflect complementary lipid-metabolic and hypoperfusion-inflammatory pathways. The nomogram combines these biomarkers with hemodynamic and respiratory severity parameters and may support early risk stratification, but requires external multicenter validation before routine clinical use.