title: Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction at admission: a descriptive study.
abstract: BACKGROUND
  Blood lactate measurements can be used as an indicator of hemodynamic impairment and relate to mortality in various forms of shock. Little is known at the moment concerning the clinical correlates of systemic lactate in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  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 = 1,176) was divided into tertiles with lactate levels ≤ 1.1 (n = 410), 1.2 to 1.7 (n = 398) and ≥ 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 to 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 percutaneous coronary intervention (PCI). In particular, acute mortality was related to admission lactates ≥ 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.
authors.affiliation: Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1 Groningen, The Netherlands. r.p.vermeulen@thorax.umcg.nl
authors.forename: Robert P
authors.initials: RP
authors.lastname: Vermeulen
authors.forename: Miriam
authors.initials: M
authors.lastname: Hoekstra
authors.forename: Maarten Wn
authors.initials: MW
authors.lastname: Nijsten
authors.forename: Iwan C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: L Joost
authors.initials: LJ
authors.lastname: van Pelt
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Jessurun
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Ad F
authors.initials: AF
authors.lastname: van den Heuvel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005263:Femoral Artery / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D010343:Patient Admission; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000097:blood* / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
references.citation: Crit Care. 2009;13(5):R157
references.pmid: 19799772
references.citation: J Am Coll Cardiol. 2007 Oct 30;50(18):1752-8
references.pmid: 17964038
references.citation: Int Heart J. 2008 Jan;49(1):13-24
references.pmid: 18360061
references.citation: Am Heart J. 2008 Apr;155(4):673-9
references.pmid: 18371475
references.citation: Eur J Anaesthesiol. 2009 Oct;26(10):856-62
references.pmid: 19367169
references.citation: Heart Fail Rev. 2002 Apr;7(2):115-30
references.pmid: 11988636
references.citation: Acad Emerg Med. 2005 Feb;12(2):106-13
references.pmid: 15692129
references.citation: Chest. 1985 May;87(5):580-4
references.pmid: 3987371
references.citation: Crit Care Med. 2009 Oct;37(10):2827-39
references.pmid: 19707124
references.citation: Am J Cardiol. 1991 Mar 15;67(7):565-8
references.pmid: 2000787
references.citation: Am Heart J. 2005 Aug;150(2):358-64
references.pmid: 16086943
references.citation: Shock. 2007 Jul;28(1):35-8
references.pmid: 17510606
references.citation: Crit Care Med. 2006 Apr;34(4):950-7
references.pmid: 16484889
references.citation: Clin Biochem. 2003 Mar;36(2):103-7
references.pmid: 12633758
references.citation: J Am Coll Cardiol. 2006 Jan 17;47(2):289-95
references.pmid: 16412849
references.citation: Circulation. 1970 Jun;41(6):989-1001
references.pmid: 5482913
references.citation: Int J Cardiol. 2007 Jan 8;114(2):176-82
references.pmid: 16737749
references.citation: Circulation. 1998 Jun 16;97(23):2302-6
references.pmid: 9639373
references.citation: Clin Chem. 1994 Jul;40(7 Pt 1):1327-30
references.pmid: 8013108
references.citation: Circulation. 1981 Jun;63(6):1273-9
references.pmid: 6784963
references.citation: Am J Med. 1961 Jun;30:840-8
references.pmid: 13716482
references.citation: Crit Care. 2008;12(6):R160
references.pmid: 19091118
references.citation: Resuscitation. 2001 Dec;51(3):297-300
references.pmid: 11738782
references.citation: Intensive Care Med. 2008 Sep;34(9):1662-8
references.pmid: 18542920
references.citation: Am J Clin Pathol. 2007 Jul;128(1):168-71
references.pmid: 17580286
references.citation: Rev Assoc Med Bras (1992). 2008 Mar-Apr;54(2):116-21
references.pmid: 18506318
references.citation: Crit Care Med. 2006 Aug;34(8):2035-42
references.pmid: 16775569
references.citation: Ann Emerg Med. 2005 May;45(5):524-8
references.pmid: 15855951
references.citation: Scand J Clin Lab Invest Suppl. 1996;224:107-10
references.pmid: 8865424
references.citation: Ann Emerg Med. 2008 Dec;52(6):665-76
references.pmid: 19027496