• Shock · Mar 2019

    Multicenter Study Clinical Trial

    Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction.

    • Martin Frydland, Jacob Eifer Møller, Sebastian Wiberg, Matias Greve Lindholm, Rikke Hansen, Henriques Jose P S JPS AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands., Ole Kristian Møller-Helgestad, Lia Evi Bang, Ruth Frikke-Schmidt, Jens Peter Goetze, Nanna Louise Junker Udesen, Thomsen Jakob Hartvig JH Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Dagmar M Ouweneel, Laust Obling, Hanne Berg Ravn, Lene Holmvang, Lisette Okkels Jensen, Jesper Kjaergaard, and Christian Hassager.
    • Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
    • Shock. 2019 Mar 1; 51 (3): 321-327.

    AimsThe diagnosis of cardiogenic shock depends on clinical signs of poor perfusion and low blood pressure. Lactate concentration will increase with poor tissue perfusion, and it has prognostic value in cardiogenic shock patients. We sought to assess the prognostic value of lactate concentration in subjects admitted with suspected ST-elevation myocardial infarction (STEMI).Methods And ResultsIn 2,094 (93%) out of 2,247 consecutive suspected STEMI-subjects, lactate concentration was measured on admission. The prognostic value of lactate concentration on 30-day mortality was assessed in addition to clinical signs of peripheral hypoperfusion, systolic blood pressure (sBP), and left ventricular ejection fraction (LVEF) in multivariable models.Lactate concentration added prognostic information beyond signs of peripheral hypoperfusion, sBP, and LVEF, and was independently associated with 30-day mortality (hazard ratio [95% confidence interval] 1.11 [1.07-1.14], P < 0.0001). Lactate also provided predictive information on 30-day mortality to the combination of signs of peripheral hypoperfusion, sBP, and LVEF (area under the receiver-operating characteristics curve = 0.88 vs. 0.83, P < 0.0001).ConclusionsIn conclusion, admission lactate concentration in suspected STEMI-subjects contains prognostic information on 30-day mortality when added to variables used in cardiogenic shock-definition. We recommend lactate measurement in STEMI-subjects, especially when signs of compromised hemodynamics are present.

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