The online version of this article (doi:10.1186/cc9253) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
RV collected data, analyzed and interpreted the data, and drafted the manuscript. MH helped with the analyses and corrected the manuscript drafts. MN and FZ conceived the study, analyzed and interpreted the data, and drafted and corrected the manuscript. IH and TJ helped with interpreting the data and corrected the manuscript drafts. GJ, AH and JP assisted in data collection and corrected manuscript drafts. RV, MN and FZ are responsible for the paper as a whole.
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).
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.
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%).
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.
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- Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction at admission: a descriptive study
Robert P Vermeulen
Maarten WN Nijsten
Iwan C van der Horst
L Joost van Pelt
Gillian A Jessurun
Ad F van den Heuvel
- BioMed Central
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