Evaluation of acid-base balance in ST-elevation myocardial infarction in the early phase: a prognostic tool?
OBJECTIVE
Metabolic acidosis has been described after myocardial infarction, but little data are available on the acid-base imbalance in ST-elevation myocardial infarction (STEMI) submitted to mechanical revascularization, and earlier studies on this topic differ with respect to patients' selection criteria, treatment and evaluated parameters.


METHODS
We assessed admission base excess, anion gap, and lactate in 445 consecutive patients with STEMI submitted to primary percutaneous coronary intervention and whether its evaluation could help in identifying patients at a higher risk for in-hospital mortality and complications (acute pulmonary edema and arrhythmias).


RESULTS
At backward stepwise logistic regression analysis, the following variables were independently associated with intra-ICCU mortality: age [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.02-1.10; P = 0.006], estimated glumerular filtration rate (OR 0.98; 95% CI 0.96-0.99; P= 0.010), Tn I (OR 1.006; 95% CI 1.004-1.008; P <0.001), and base excess (OR 0.90; 95% CI 0.82-0.99; P = 0.038); Hosmer-Lemeshow v2: 5.69, P = 0.681. At backward stepwise logistic regression analysis, the following variables were independently associated with intra-ICCU complications: left ventricular ejection fraction (OR 0.95; 95% CI 0.91-0.98; P = 0.005) and lactic acid (OR 1.31; 95% CI 1.10-1.57; P =0.003); Hosmer-Lemeshow v2: 4.11, P = 0.847.


CONCLUSIONS
According to our findings, the evaluation of base excess and lactate in the early phase of STEMI provides the bedside clinicians with useful tools for early risk stratification. In fact, base excess proved to be an independent predictor for intra-ICCU mortality, whereas lactate represented an independent marker for intra-ICCU complications.
Lazzeri
Chiara
C
Intensive Cardiac Coronary Unit, Department of Heart and Vessel, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. lazzeric@libero.it
Valente
Serafina
S
Chiostri
Marco
M
Picariello
Claudio
C
Gensini
Gian Franco
GF
D000136:Acid-Base Equilibrium; D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001639:Bicarbonates / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003325:Coronary Care Units; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D019344:Lactic Acid / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011654:Pulmonary Edema / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D001639:Bicarbonates; D015415:Biomarkers; D019344:Lactic Acid