Objective To explore the clinical value of transthoracic echocardiography （TTE） and related clinical indexesin the evaluation of percutaneous coronary intervention （PCI） supported by arteriovenous extracorporeal membrane oxygenation （VA-ECMO） in the treatment of patients with acute myocardial ischemia complicated by refractory cardiogenic shock. Methods The clinical data of 70 patients with acute myocardial ischemia complicated by refractory cardiogenic shock treated with VA-ECMO in the First Hospital of Lanzhou University from January 2022 to April 2023 were analyzed retrospectively. According to the success of VA-ECMO withdrawal， the patients were divided into success group （54 cases） and failure group （16 cases）. The general data， Intraoperative condition， hemodynamic and biochemical indexes of the two groups were compared， and the independent risk factors affecting the clinical outcome were analyzed. Results The time of ECMO assistance in the success group was significantly shorter than that in the failure group （P < 0.05）. There was no significant difference inother general information between the two groups（all P > 0.05）. There was no significant difference in preoperative TIMI grade， number of diseased vascular branches， use of IVUS， ECG results and SYNTAX score between the two groups（all P > 0.05）. Compared with those before treatment， arterial oxygen saturation （SaO₂）， left ventricular stroke volume （LVSV）， left ventricular ejection fraction （LVEF）， mitral annulus systolic velocity （Sa）， aortic orifice forward flow spectrum （AV）， velocity-time integral （VTI） and tricuspid annulus systolic displacement （TAPSE） increased significantly after ECMO plus PCI treatment （all P < 0.05）. Left ventricular end systolic volume （LVESV） decreased significantly （P < 0.05）. Compared with those in the failure group， the heart rate （HR）， shock index （SI）， blood lactic acid （Lac）， C-reactive protein （CRP）， aspartate aminotransferase （AST） and total bilirubin （TBIL） were lower in the success group （all P < 0.05）. There was no significant difference in ECMO flow and SaO₂ between the two groups（P > 0.05）. Univariate logistic regression analysis showed that ECMO-supporting time， HR， Lac， CRP， AST and TBIL were the influencing factors of weaning failure in patients with acute myocardial ischemia complicated with refractory cardiogenic shock. Conclusion VA-ECMO combined with PCI can significantly improve cardiac function in patients with acute myocardial ischemia complicated by refractory cardiogenic shock.Echocardiographic parameters （LVESV， LVSV， LVEF， Sa， AV， VTI， TAPSE） and clinical indexes （HR， Lac， CRP， AST， TBIL） have certain clinical value for theprognosis.