Postgraduate medicine最新文献

{"title":"Challenge of diagnosing celiac disease in pediatric type 1 diabetes mellitus: lessons from long-term serological surveillance.","authors":"Selcuk Teke, Ceyda Tuna Kırsaclıoglu, Necati Emrecan Turk, Ahmet Kara, Zehra Aycan, Aydan Kansu, Arzu Ensari, Zarife Kuloglu","doi":"10.1080/00325481.2026.2686458","DOIUrl":"10.1080/00325481.2026.2686458","url":null,"abstract":"<p><strong>Objectives: </strong>Children with type 1 diabetes mellitus (T1DM) have an increased risk of developing celiac disease (CD), frequently without typical symptoms. However, the optimal screening strategies and diagnostic threshold for tissue transglutaminase antibody immunoglobulin A (tTG-IgA) remain controversial. This study aimed to assess the performance of CD screening tests and identify optimal serological thresholds in children with T1DM.</p><p><strong>Methods: </strong>This 12-year retrospective single-center cohort study from Türkiye included 282 newly diagnosed T1DM children without prior CD. Patients with <2 CD screenings performed ≥ 6 months apart or incomplete records were excluded. Among the remaining cohort, 206 patients had longitudinal screening for CD. Of them, only 24 patients who had seropositivity constituted the main analytical sample for assessing the diagnostic performance of tTG-IgA levels using receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Among the 206 patients with longitudinal CD screening, tTG-IgA positivity was observed in 24 patients (11.6%), either at T1DM diagnosis (70.8%) or during follow-up (29.2%). Biopsy-confirmed CD was diagnosed in 4.8% of the cohort. The remaining patients had fluctuations in tTG-IgA level; 50% became seronegative, but two-thirds became positive again. ROC analysis identified an optimal tTG-IgA threshold of ≥7.3× the upper limit of normal (ULN), yielding an area under the curve of 0.81, sensitivity of 70%, and specificity of 100%. Notably, 8.3% of biopsy-confirmed CD cases had tTG-IgA levels < 3×ULN.</p><p><strong>Conclusion: </strong>Although tTG-IgA level ≥7.3×ULN is highly predictive of CD in children with T1DM, lower levels may also be noteworthy. Continuous long-term monitoring and a multi-dimensional approach are crucial for early and accurate CD diagnosis in this high-risk group.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"549-556"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bayesian dosage adjustment of tacrolimus in kidney transplantation: a systematic review.","authors":"Pasumarthi Tejashree, Mandar B Rao, Pattanaik Smita, Vijay Ivaturi, Raghu Chandrashekar, Anbu Raj Elstin, Surulivelrajan Mallayasamy","doi":"10.1080/00325481.2026.2675731","DOIUrl":"10.1080/00325481.2026.2675731","url":null,"abstract":"<p><strong>Background: </strong>Tacrolimus is a first-line immunosuppressant used in renal transplant patients but exhibits a narrow therapeutic index and high inter-individual variability. Although therapeutic drug monitoring (TDM) using trough concentrations (C₀) is common, it may not consistently reflect true drug exposure. The area under the concentration-time curve (AUC) is a more realistic metric, and Bayesian estimation methods often improve the precision of AUC estimations using prior pharmacokinetic knowledge.</p><p><strong>Methods: </strong>We conducted a systematic literature search of PubMed, Scopus, and Embase from inception to August 2024 for studies utilizing Bayesian approaches for estimating tacrolimus exposure in renal transplant patients. Studies were included if they employed Bayesian techniques for AUC estimation, dose adjustment using population pharmacokinetic (PopPk) models, or limited sampling strategies. Data were extracted, appraised using the Critical Appraisal of Clinical Pharmacokinetic Studies (CACPK) tool, and summarized.</p><p><strong>Results: </strong>Most studies reported that Bayesian methods, particularly Maximum a Posteriori Bayesian Estimation (MAP-BE), provided superior AUC prediction compared to traditional methods. Tools such as Immunosuppressants Bayesian dose Adjustment (ISBA) and softwares such as NONMEM were frequently used. Most studies support the inclusion of trough and post-dose samples for >2 h for accurate predictions.</p><p><strong>Conclusion: </strong>Bayesian approaches demonstrate enhanced accuracy in tacrolimus dose adjustment for renal transplant patients, outperforming conventional TDM strategies, and showing potential for broader clinical applications.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"517-529"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sjögren's disease complicated with ischemic bowel disease: a case report.","authors":"Feifei Jiang, Ying Li","doi":"10.1080/00325481.2026.2683179","DOIUrl":"10.1080/00325481.2026.2683179","url":null,"abstract":"<p><strong>Background: </strong>The etiology of ischemic bowel disease (IBD) is complex and multifactorial, traditionally associated primarily with atherosclerosis, cardiogenic embolism, hypercoagulable states, and vascular surgery. However, IBD secondary to Sjögren's disease (SjD) remains rarely documented in the literature.</p><p><strong>Case presentation: </strong>We report an 87-year-old female patient who was presented with abdominal pain and bloody stools. A diagnosis of IBD was considered following colonoscopy, and after a comprehensive workup to rule out common etiologies, the final diagnosis of intestinal ischemic lesions potentially associated with SjD was established.</p><p><strong>Conclusion: </strong>This case suggests that SjD may be a rare yet potential contributing factor of IBD - a condition that is often overlooked in clinical practice. It highlights the importance of including SjD in the differential diagnosis of unexplained IBD, beyond conventional etiologies.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"507-510"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in postoperative rehabilitation of chronic patellar tendon rupture following delayed surgical reconstruction: a case report.","authors":"Cristopher Espinoza-Otárola, Gonzalo Arias-Álvarez, Francisco Guede-Rojas, Edison Velásquez, Claudio Carvajal-Parodi","doi":"10.1080/00325481.2026.2686464","DOIUrl":"10.1080/00325481.2026.2686464","url":null,"abstract":"<p><strong>Background: </strong>Chronic patellar tendon rupture (CPTR) represents a rare but disabling injury that presents major surgical and rehabilitative challenges, especially when diagnosis and repair are delayed.</p><p><strong>Case presentation: </strong>This case describes a 33-year-old male who sustained a right knee injury during recreational sport that remained untreated for 12 months. Magnetic resonance imaging (MRI) confirmed CPTR with marked retraction and patella alta. Surgical reconstruction using a semitendinosus-gracilis autograft was followed by a six-month, phase-based rehabilitation program emphasizing protected mobility, progressive strengthening, and neuromuscular control. Throughout supervised sessions, the patient achieved clinically meaningful but partial functional improvement: pain decreased from VAS 6 to zero, and KOOS subscales improved relative to baseline values. Although postoperative MRI revealed partial graft rupture, residual laxity, and persistent patellar elevation, the patient regained independent ambulation, reported high satisfaction, and demonstrated a residual extension lag of 5-10°.</p><p><strong>Conclusion: </strong>This case underscores the complex relationship between structural imaging findings and functional recovery following delayed CPTR reconstruction, illustrating that partial functional improvement may coexist with persistent structural abnormalities. Additionally, socioeconomic barriers that delayed access to specialized care significantly shaped the recovery trajectory, reinforcing the importance of early diagnosis and integrated rehabilitation strategies in complex extensor-mechanism injuries.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"495-506"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the MIND diet score related to polyendocrine metabolic ovarian syndrome and its phenotypes? A case-control study.","authors":"Ramazan Mert Atan, Alihan Tigli, Kevser Tari, Yakup Baykus, Rulin Deniz","doi":"10.1080/00325481.2026.2687152","DOIUrl":"10.1080/00325481.2026.2687152","url":null,"abstract":"<p><strong>Objectives: </strong>Dietary habits are increasingly recognized as an important modifiable risk factor in the management and prevention of polyendocrine metabolic ovarian syndrome (PMOS). However, evidence regarding the relationship between the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet and PMOS is limited. The aim of this study is to investigate the relationship between the MIND diet score and PMOS, as well as its various phenotypes.</p><p><strong>Methods: </strong>This case-control study was conducted on 367 women (161 cases, 206 controls) who attended a gynecology and obstetrics clinic. PMOS and its phenotypes were determined according to the Rotterdam criteria. Data were collected face-to-face using the Demographic Information Form, anthropometric measurements, and the MIND Diet Adherence Scale. Multivariate logistic regression was used to estimate the relationship between the MIND diet and PMOS and its phenotypes. The significance level was <i>p</i> < 0.05.</p><p><strong>Results: </strong>The median age of the case and control groups was 22.00 years. Phenotype A was the most prevalent in the case group (43.5%). In model 4, which included all confounding factors, it was found that the likelihood of PMOS was significantly lower in the Q4 group who had the highest MIND diet score compared to the Q1 group (AOR:0.166; 95% CI: 0.073-0.378). In terms of phenotypes, the likelihood of having phenotypes A, C, and D was significantly lower in the Q4 group (<i>p</i> < 0.05); however, no statistically significant relationship was found for phenotype B (<i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>This case-control study found that a higher MIND diet score was associated with a lower likelihood of PMOS and of phenotypes A, C, and D.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"614-622"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary empyema treatment in the United States: predictors of surgical intervention following conservative management.","authors":"Ali Iqbal, Saikou Omar Saidy, Saqib Baig","doi":"10.1080/00325481.2026.2683189","DOIUrl":"10.1080/00325481.2026.2683189","url":null,"abstract":"<p><strong>Background: </strong>In the post-MIST-2 era, conservative-first management of empyema (antibiotics plus drainage with IET) is widely adopted, yet the real-world clinical course and predictors of surgical escalation remain unclear.</p><p><strong>Methods: </strong>Using HCUP-National Inpatient Sample (2016 through 2018), we identified adults hospitalized with a principal diagnosis of empyema (ICD-10-CM J86.9). We excluded interhospital transfers and cases with an initial invasive pleural procedure. Patients were grouped as (1) conservative only (needle drainage and/or tube thoracostomy and IET) or (2) surgical escalation after initial conservative care. Primary outcomes were escalation to invasive pleural procedures and hospital LOS; secondary outcomes included in-hospital mortality, discharge disposition, and costs. Multivariable logistic regression evaluated factors associated with escalation; negative binomial regression modeled LOS.</p><p><strong>Results: </strong>Among 2,336 admissions, 1,972 (84.4%) were managed conservatively and 364 (15.6%) escalated. IET was documented in 345/2,336 (14.8%) admissions. Patients were similar in age and sex. Escalated patients underwent more procedures (mean 6.4 vs 3.7). LOS was longer in the escalated group (14.4 vs 11.0 days), and mean costs were higher ($38,638 vs $26,212). In-hospital mortality remained low in both cohorts (2.3% in the conservative group vs 1.1% in the escalated group). In adjusted analyses, IET was associated with lower odds of invasive escalation (aOR 0.23; <i>p</i> < 0.001), while Black race (aOR 1.76; <i>p</i> = 0.003) and Hispanic ethnicity (aOR 1.56; <i>p</i> = 0.04) were associated with higher odds. Escalation was associated with longer LOS (IRR 1.33; <i>p</i> < 0.001), and IET was associated with a modest increase in LOS (IRR 1.12; <i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>Most adults with empyema managed initially with noninvasive pleural procedures did not require invasive escalation during index admission. Escalation was associated with greater procedural burden, longer LOS, and higher costs. IET was associated with lower odds of escalation but slightly longer LOS.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"540-548"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between frailty and major chronic disease-free life expectancy: a large community-based longitudinal study.","authors":"Shuqi Wang, Jiao Wang, Jie Guo, Abigail Dove, Xiuying Qi, Debora Rizzuto, Weili Xu","doi":"10.1080/00325481.2026.2687153","DOIUrl":"10.1080/00325481.2026.2687153","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to investigate the extent to which frailty is associated with chronic disease-free life expectancy (LE), focusing on major chronic diseases such as cardiovascular disease [CVD], diabetes, dementia, and cancer, in both males and females.</p><p><strong>Methods: </strong>Within the UK Biobank, 392,982 chronic disease-free participants (mean age: 55.8 ± 8.1 years; 55.1% female) were followed for up to 16 years. Frailty at baseline was assessed based on five criteria: self-reported weight loss, exhaustion, low physical activity, slow walking speed, and poor grip strength. All participants were categorized as non-frail (0 criteria), pre-frail (1-2 criteria), and frail (≥3 criteria). CVD, diabetes, dementia, cancer, and death were ascertained through medical records and the death registry. Data were analyzed using parametric proportional hazard regression models with a Gompertz distribution in a multi-state context.</p><p><strong>Results: </strong>At baseline, there were 113,421 (64.3%), 59,553 (33.7%), and 3,516 (2.0%) non-frail, pre-frail, and frail males, respectively, and 125,285 (57.9%), 83,935 (38.8%), and 7,272 (3.3%) corresponding females. At age 50, the estimated chronic disease-free LE (95% confidence interval) for non-frail, pre-frail, and frail males were 20.64 (20.31, 21.01), 18.73 (18.41, 19.13), and 14.75 (14.40, 15.20), with corresponding LE for females of 25.77 (25.34, 26.15), 23.65 (23.22, 24.07), and 19.15 (18.70, 19.67). Respectively, chronic disease-free LE was 5.90 (3.95, 7.84) and 6.62 (4.47, 8.77) years shorter for males and females who were frail compared to non-frail.</p><p><strong>Conclusion: </strong>Frailty is associated with more than 5 years shorter chronic disease-free LE in both males and females.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"604-613"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of shock index in acute coronary syndrome mortality prediction: a systematic review and meta-analysis.","authors":"Pandit Bagus Tri Saputra, Roy Bagus Kurniawan, Dinda Dwi Purwati, Pratista Oktafia, Ariikah Dyah Lamara, Arief Gusnanto, Yudi Her Oktaviono, Firas Farisi Alkaff","doi":"10.1080/00325481.2026.2675088","DOIUrl":"10.1080/00325481.2026.2675088","url":null,"abstract":"<p><strong>Background: </strong>Shock index (SI) is a simple parameter in various diseases. Its performance in acute coronary syndrome (ACS) varies across studies. This systematic review evaluates SI's performance for ACS mortality prediction.</p><p><strong>Method: </strong>On 16 March 2025, we systematically searched six databases. This study included observational studies examining mortality outcomes in patients with ACS. Using random-effect models, we estimated the pooled odds ratio (OR), sensitivity, and specificity of SI in predicting ACS mortality. Additionally, we generated a summary receiver operating characteristics (sROC) curve and its area under the curve (AUC).</p><p><strong>Results: </strong>This systematic review included 18 studies with 75,237 patients. High SI was significantly associated with all-time mortality (OR 4.82; OR 2.71 after publication bias adjustment). The association was stronger for in-hospital mortality (OR 6.46) but decreased for long-term mortality (OR 4.00). The SI cutoff values varied across studies, ranging from 0.5 to 1.6. The sensitivity and specificity of SI in predicting all-time mortality were 67.11% (95% CI: 61.48-72.74) and 73.21% (95% CI: 67.21-79.22), respectively, with an AUC of 0.69 (95% CI: 0.65-0.72). Its performance was higher for in-hospital mortality (sensitivity 64.22%, specificity 78.96%, AUC 0.71) and long-term mortality (sensitivity 61.23%, specificity 63.99%, AUC 0.70).</p><p><strong>Conclusion: </strong>High SI was associated with and has predictive value for short-term and long-term mortality prediction in ACS setting.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"567-579"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of biologics for eosinophilic granulomatosis with polyangiitis: a network meta-analysis.","authors":"Yuling Zhang, Yi Yang","doi":"10.1080/00325481.2026.2675084","DOIUrl":"10.1080/00325481.2026.2675084","url":null,"abstract":"<p><strong>Objectives: </strong>Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis affecting small-to-medium size vessels, characterized by eosinophil infiltration and extravascular granulomas in multiple organs. Biologics have emerged as promising therapeutic options for EGPA management, and this network meta-analysis aimed to comprehensively compare their efficacy and safety profiles.</p><p><strong>Methods: </strong>A systematic literature search was conducted across PubMed, EMBASE, Cochrane Library, Web of Science, and Clinicaltrial.gov (inception-15 October 2025) for studies of biologics in adult EGPA patients. Network meta-analysis with a random-effects model was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcome (remission rate), secondary outcomes (oral corticosteroid [OCS] dose and relapse rate), and adverse events (AEs) were compared.</p><p><strong>Results: </strong>Seventeen articles involving 1150 participants and 4 biologics (mepolizumab, benralizumab, rituximab, and omalizumab) were included. Compared to conventional therapy/placebo, benralizumab (OR = 6.18, 95% CI: 1.98-19.31) and mepolizumab (300 mg: OR = 5.83, 95% CI: 2.00-17.02; 100 mg: OR = 3.70, 95% CI: 1.26-10.92) were associated with the phase 3 Mepolizumab in Relapsing or Refractory EGPA (MIRRA)-defined remission of EGPA patients. Benralizumab and mepolizumab (300 mg) also exhibited favorable performance in reducing OCS dosage, and preventing asthma relapse or vasculitis relapse. Notably, the overall and serious AE rates of biologics were comparable to conventional therapy or placebo.</p><p><strong>Conclusion: </strong>Benralizumab and mepolizumab were potentially associated with clinical remission and OCS usage reduction for EGPA patients, with safety profiles similar to placebo.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"580-592"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation in cardiogenic shock: evidence, limitations, and patient selection in the contemporary era.","authors":"Udit Choubey, Kartik Mehta, Sreshatha Vashist, Heena Arshad, Namita Ruhela, Nabeel Akhtar, Rohit Jain","doi":"10.1080/00325481.2026.2679308","DOIUrl":"10.1080/00325481.2026.2679308","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a life-threatening condition with severely impaired myocardial contractility, causing systemic hypoperfusion, tissue hypoxia, and organ dysfunction. Despite the advances in revascularisation and pharmacological therapies, CS carries high mortality among patients with acute myocardial infarctions and other acute cardiac syndromes. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) offers short-term mechanical circulatory support in refractory CS by restoring systemic perfusion and maintaining end-organ oxygenation. This narrative review aims to explain the physiological basis of V-A ECMO, summarize the findings from randomized clinical trials (RCTs) and observational studies, and evaluate the clinical factors that affect mortality outcomes in CS. Recent RCTs assessing routine early V-A ECMO initiation in acute myocardial infarction - related CS include ECLS-SHOCK, ECMO-CS, and EURO-SHOCK. The results did not show a clear early mortality benefit with routine ECMO initiation and reported higher rates of bleeding and vascular complications. Appropriate patient selection based on shock phenotype, optimal timing of support, clinical assessment, and management of V-A ECMO-associated complications are critical determinants of clinical effectiveness. It is still a valuable rescue option for refractory CS when appropriately selected based on reversibility potential and institutional capabilities, rather than as routine first-line therapy for all patients with acute MI-related shock.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"530-539"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}