TY - JOUR
T1 - Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction
AU - Frydland, Martin
AU - Møller, Jacob Eifer
AU - Wiberg, Sebastian
AU - Lindholm, Matias Greve
AU - Hansen, Rikke
AU - Henriques, Jose P S
AU - Møller-Helgestad, Ole Kristian
AU - Bang, Lia Evi
AU - Frikke-Schmidt, Ruth
AU - Goetze, Jens Peter
AU - Udesen, Nanna Louise Junker
AU - Thomsen, Jakob Hartvig
AU - Ouweneel, Dagmar M
AU - Obling, Laust
AU - Ravn, Hanne Berg
AU - Holmvang, Lene
AU - Jensen, Lisette Okkels
AU - Kjaergaard, Jesper
AU - Hassager, Christian
PY - 2019/3
Y1 - 2019/3
N2 - AIMS: The 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 RESULTS: In 2094 (93%) out of 2247 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).CONCLUSIONS: In 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.
AB - AIMS: The 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 RESULTS: In 2094 (93%) out of 2247 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).CONCLUSIONS: In 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.
KW - Cardiogenic shock
KW - lactate
KW - mortality
KW - risk stratification
KW - STEMI
U2 - 10.1097/SHK.0000000000001191
DO - 10.1097/SHK.0000000000001191
M3 - Journal article
C2 - 30286032
SN - 1073-2322
VL - 51
SP - 321
EP - 327
JO - Shock
JF - Shock
IS - 3
ER -