A Novel ApoB/ApoA1 Ratio-Integrated Nomogram to Predict Cardiogenic Shock After Acute Myocardial Infarction

Background: Despite advances in treatment, cardiogenic shock (CS) remains a highly lethal complication of acute myocardial infarction (AMI), with mortality rates still exceeding 40%. Early identification of high-risk patients is critical, yet existing risk-stratification tools lack precision, particularly in integrating novel biomarkers such as the apolipoprotein B/A1 (ApoB/ApoA1) ratio, which reflects atherogenic lipid imbalance and has shown predictive value in cardiovascular disease. Methods: This retrospective cohort study included patients admitted with an acute coronary syndrome between December 2022 and July 2025. Results: Using the least absolute shrinkage and selection operator (LASSO) regression, a predictive nomogram was developed incorporating eight independent predictors: heart rate, respiratory rate, systolic blood pressure, white blood cell count, D-dimer, albumin, glucose, and the ApoB/ApoA1 ratio. The model demonstrated strong discriminatory performance, with an area under the curve (AUC) of 0.839 in the training cohort and 0.832 in the validation cohort. Calibration and decision curve analyses further supported the clinical utility of the nomogram. Conclusions: The inclusion of the ApoB/ApoA1 ratio, a marker associated with endothelial dysfunction, plaque instability, and metabolic dysregulation, adds significant prognostic value beyond conventional parameters. This nomogram provides a practical tool for early risk stratification, potentially guiding timely interventions and improving outcomes in high-risk patients with AMI.