Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction at admission: a descriptive study.
Crit Care. 2010 Sep 9;14(5):R164
Authors: Vermeulen RP, Hoekstra M, Nijsten MW, van der Horst IC, van Pelt J, Jessurun GA, Jaarsma T, Zijlstra F, van den Heuvel AF
ABSTRACT: INTRODUCTION: Blood lactate measurements can be used as an indicator of hemodynamic impairment and relate to mortality in various forms of shock. On the clinical correlates of systemic lactate in patients with ST-segment elevation myocardial infarction (STEMI) little is known at the moment. METHODS: To assess the relation of systemic arterial lactate levels in STEMI patients with clinical correlates at presentation in the catheterization laboratory, we measured arterial lactate levels with a rapid point-of-care technique, immediately following femoral sheath insertion. The study population (n=1176) was divided into tertiles with lactate levels [less than or equal to] 1.1 (n=410), 1.2-1.7 (n=398) and [greater than or equal to] 1.8 mmol/l (n=368). We compared both baseline characteristics and outcome measures of the three lactate groups. RESULTS: Factors independently associated with higher lactate levels were hypotension, heart rate, thrombolysis in myocardial infarction (TIMI) flow 0-1, diabetes and non-smoking. Mortality at 30 days in the three groups was 2.0%, 1.5% and 6.5%. The latter group also showed lower blush grades and greater enzymatic infarct sizes. An intra aortic balloon pump (IABP) was used more frequently in patients with higher lactate levels (4.2%, 7.6% and 14.7%). CONCLUSIONS: In STEMI patients, impaired hemodynamics, worse TIMI flow and non-smoking were related to increased arterial lactate levels. Higher lactate levels were independently related with 30-day mortality and an overall worse response to PCI. In particular, acute mortality was related to admission lactates [greater than or equal to] 1.8 mmol/L. Point-of-care measurement of arterial lactate at admission in patients with STEMI has the potential to improve acute risk stratification.
PMID: 20825687 [PubMed - as supplied by publisher]