Lactate in the acute phase of ST-elevation myocardial infarction treated with mechanical revascularization: a single-center experience.
OBJECTIVE
The prognostic role (if any) of lactate for early mortality in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) is so far not elucidated. We therefore assessed whether lactic acid (LA) was a prognostic predictor for early mortality in 807 patients with STEMI submitted to primary PCI consecutively admitted to our intensive cardiac care unit (ICCU) from January 1, 2006, to December 31, 2009.


RESULTS
Higher levels of LA were found in older patients (P = .025) and were associated with a progressive decline in estimated glomerular filtration rate (P < .001) and in ejection fraction (P < .001). The increase in LA values paralleled the progressive increase in glucose values, peak glycemia, troponin I, N-terminal pro-brain natriuretic peptide, and uric acid (P < .001, P < .001, P < .001, P = .018, and P = .006, respectively). The in-ICCU mortality rate was highest in the third LA tertile (P < .001). Lactate levels were independent predictors for in-hospital mortality only in patients with Killip classes III to IV (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.05-1.30, P = .003). In addition, age (OR, 1.11; 95% CI, 1.03-1.19, P = .006) and leukocytes (OR, 1.17; 95% CI, 1.03-1.33, P = .015) were independent predictors for in-hospital mortality when adjusted for PCI failure.


CONCLUSIONS
In patients with STEMI submitted to primary PCI, blood lactate is a prognostic marker for early mortality only in the subgroup with advanced Killip class. The degree of hemodynamic impairment (as indicated by Killip class), of myocardial ischemia (as inferred by troponin I), and glucose values are the main factors influencing lactate concentrations in the early phase of STEMI.
Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy. lazzeric@libero.it
Chiara
C
Lazzeri
Serafina
S
Valente
Marco
M
Chiostri
Claudio
C
Picariello
Gian Franco
GF
Gensini
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000706:statistics & numerical data; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D013318:Stroke Volume; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D007773:Lactates; D019210:Troponin I