The predictive value of cumulative lactate dehydrogenase release within the first 72 h of acute myocardial infarction in patients treated with primary angioplasty.
BACKGROUND
In patients with acute myocardial infarction, estimation of infarct size by cumulative lactate dehydrogenase release at 72 h (LDHQ(72)) is a simple and widely used method. Our objective was to study the value of estimating infarct size, by the cumulative release of LDH over 72, 60, 48 and 36 h in predicting left ventricular ejection fraction (LV(ef)) and cardiac death at 1 year.


METHODS
In the Zwolle Infarction Study infarct size estimated as LDHQ was calculated in 1224 patients treated with primary percutaneous coronary intervention for acute myocardial infarction between December 1993 and June 2001. Patients were categorized as having small (LDHQ(72)<800 U/L), medium (LDHQ(72) 800-2500 U/L) or large (LDHQ(72)>2500 U/L) myocardial infarction.


RESULTS
LDHQ(72) was closely correlated with LDHQ(60), LDHQ(48) and LDHQ(36) (r = 0.998, 0.993 and 0.987, respectively, P <0.0001). The relations between LDHQ infarct size classification and mean LV(ef) (51% vs 45% vs 35%, P <0.001) or cardiac death at 1 year (0-0.3% vs 0.7-1% vs 6-8%) showed a similar pattern, irrespective of whether LDH was measured up to 36, 48, 60 or 72 h.


CONCLUSIONS
Infarct size classification based on LDHQ(36) is an objective and widely available method for early risk stratification in patients treated with primary angioplasty for acute ST-segment elevation myocardial infarction.
Elsman
Peter
P
Department of Cardiology, Isala Klinieken location de Weezenlanden, 8011 JW Zwolle, The Netherlands.
Zijlstra
Felix
F
Miedema
Kor
K
Hoorntje
Jan C A
JC
Dikkeschei
Lambert D
LD
Slingerland
Robbert J
RJ
Reiffers
Stoffer
S
de Boer
Menko-Jan
MJ
Suryapranata
Harry
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors
D015415:Biomarkers; D007770:L-Lactate Dehydrogenase