Antithrombin III at Admission as a New Predictive Factor for Mortality in ECMO for Cardiogenic Shock Caused by Acute Myocardial Infarction

Objectives: Extracorporeal membrane oxygenation (ECMO) is a technique increasingly used in the practice of intensive therapy for extracorporeal gas exchange and/or circulatory support in patients with acute respiratory and/or cardiac failure, when conventional treatment modalities are ineffective. We aimed to investigate impacts of antithrombin III at admission on ECMO outcomes in cardiogenic shockcomplicated by acute myocardial infarction. Methods: We retrospectively studied patients with acute myocardial infarctioncomplicated by cardiogenic shock undergoing ECMO in four hospitals in China. Results: The in-hospital mortality rate was 47.8% (194/406). The antithrombin III at admission of the in-hospital death group (n=194) and the survival group (n=212) were 45.70 ± 21.57 and 50.97 ± 25.37 ng/L, respectively. We decided to take 46 ng/L of antithrombin III at admission as the cut-off value for grouping and comparing the differences between the two groups. The AT III at admission＜ and ≥ 46 ng/Lgroups were similar in male gender, age, weight, Killip 3, Killip 4, hypertension, diabetes and atrial fibrillation,serum troponin, and serum creatine kinase isoenzyme. In-hospital mortalityand acute kidney injury, and serum creatinine in the AT III at admission＜46 ng/L group were significantly higher than that in the AT III at admission ≥ 46 ng/L group. By univariate and multivariate analysis, serum albumin ＜30 g/L, AT III at admission＜46 ng/L, and serum lactate were found to be related to in-hospital mortality. Conclusions: Our investigation demonstrated that low antithrombin III at admission was associated with in-hospital in cardiogenic shock secondary to acute myocardial infarction on ECMO, suggesting that monitoring AT III plasma levels may be important in the management of ECMO.