title: Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: a pilot study.
abstract: BACKGROUND
  Recent studies documented that serial lactate measurements over time may be clinically more reliable than lactate absolute value for risk stratification. The aim of the present investigation was to assess the role of lactate clearance in predicting early death in cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  51 consecutive patients with CS following STEMI were prospectively enrolled. Lactate was measured in Intensive Cardiac Care Unit (ICCU) on admission and on the twelfth hour. Logistic regression analysis was performed to identify the independent predictors for in-ICCU mortality. Receiver operating characteristic (ROC) curve was constructed in order to identify cut-off for admission lactate and for 12-h lactate clearance in relation to in-ICCU mortality. Follow-up survival rate were investigated by Kaplan-Meier curves.
  
  
  RESULTS
  At 12 h from admission, lactate clearance was higher in survivors (P=0.013). A higher in-ICCU mortality was observed in patients with 12 hours lactate clearance<10% (P=0.002). At follow up, patients with 12-h lactate clearance<10% showed a significantly lower survival rate.
  
  
  CONCLUSIONS
  In patients with CS following STEMI, 12-h lactate clearance<10% identifies a subset of patients at higher risk for death at short and long-term.
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. paola_md@virgilio.it
authors.forename: Paola
authors.initials: P
authors.lastname: Attaná
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.forename: Claudio
authors.initials: C
authors.lastname: Picariello
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D010865:Pilot Projects; D011379:Prognosis; D012372:ROC Curve; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate
chemical_list: D019344:Lactic Acid