The effect of lactate levels on prognosis in patients with ST-segment elevation myocardial infarction
The effect of lactate levels on prognosis in patients with ST-segment elevation myocardial infarction
Aim: The prognostic role of lactate for early mortality in patients with ST-segment elevation myocardial infarction (STEMI) submittedto primary percutaneous transluminal coronary angiography (PTCA) is not elucidated clearly. This study was conducted with patientsthat presented to the emergency department (ED) with STEMI and underwent PTCA to investigate whether the changes in lactatevalues from ED admission to 24 hours after PTCA affected mortality.Material and Methods: This prospective observational study on 143 patients with STEMI was conducted at emergency service andtertiary-level cardiology clinic in a public university hospital. The documentation for each patient included detailed information ondemographics, type of myocardial infarction according to electrocardiography and PTCA results, duration of hospital stay, vital signs,laboratory fidings on admission, lactate levels 24 hours after PTCA, and outcome (hospital discharge or death).Results: The lactate values are higher in non-surviving groups measured 24 hours after PTCA (P < 0.001). The differences in thelactate levels from the time of admission to 24 hours after PTCA were signifiantly lower in the non-surviving group (P < 0.001).Conclusion: Among patients presenting to the ED with STEMI, a high lactate level is associated with mortality. Also, the differencebetween lactate values of the patients after PTCA is associated with the risk of mortality. Therefore, we consider that fist lactatelevels in ED and last lactate levels after PTCA in patients with STEMI can provide physicians with an insight into the possibility ofmortality
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- 1. Attana P, Lazzeri C, Picariello C, et al. Lactate and lactate clearance in acute cardiac care patients. Eur Heart J Acute Cardiovasc Care 2012;1:115-21.
- 2. Pedersen F, Butrymovich V, Kelbaek H, et al. Shortand long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol 2014; 64:2101-8.
- 3. Borja I, Stefan J, Stefan A, et al. 2017 ESC Guidelines fort he management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Hearth J 2018;39:119-77.
- 4. Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, highrisk, surgical patients. Crit Care 2004;8:60-5.
- 5. Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 2005;45:524- 8.
- 6. Gatien M, Stiell I, Wielgosz A, et al. Diagnostic performance of venous lactate on arrival at the emergency department for myocardial infarction. Acad Emerg Med 2005;12:106-13.
- 7. Lazzeri C, Sori A, Chiostri M, et al. Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention. Eur J Anaesthesiol 2009;26:856-62.
- 8. Kossaify A, Garcia A, Succar S, et al. Perspectives on the value of biomarkers in acute cardiac care and implications for strategic management. Biomark Insights 2013;8:115-26.
- 9. Schmiechen NJ, Han C, Milzman DP. ED use of rapid lactate to evaluate patients with acute chest pain. Ann Emerg Med 1997;30:571-7.
- 10. Julian V, Jack HS, Geottrey L. Lactate predicts both Short- and Long-Term mortality in patients with and without sepsis. Infect Dis (Auckl) 2019;12:1-6.
- 11. Kawase T, Toyofuku M, Higashihara T, et al. Validation of lactate level as a predictor of early mortality in acute decompensated heart failure patients who entered intensive care unit. J Cardiol 2015;65:164-70.
- 12. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care 2010;14:25
- 13. DeGeare VS, Boura JA, Grinnes LL, et al. Predictive value of the Killip classif cation in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol 2001;87:1035-8.
- 14. Hajlar LA, Almeida JP, Fukushima JT, et al. High lactate levels are predictors of major complications after cardiac surgery. J Thorac Cardiovasc Surg 2013;146:455-60.
- 15. Lazzeri C, Valente S, Chiostri M, et al. Lactate in the acute phase of ST-elevation myocardial infarction treated with mechanical revascularization: a singlecenter experience. Am J Emerg Med 2012;30:92-6.
- 16. Park TK, Yang JH, Choi SH, et al. Clinical outcomes of patients with acute myocardial infarction complicated by severe refractory cardiogenic shock assisted with percutaneous cardiopulmonary support. Yonsei Med J 2014;55: 920-7.
- 17. Attaná P, Lazzeri C, Chiostri M, et al. Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: a pilot study. Acute Card Care 2012;14:20-6.