Research
Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction at admission: a descriptive study
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* Corresponding author: Robert P Vermeulen r.p.vermeulen@thorax.umcg.nl
1 Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1 Groningen, The Netherlands
2 Department of Critical Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1 Groningen, The Netherlands
3 Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1 Groningen, The Netherlands
4 Department of Cardiology, Scheper Ziekenhuis, Boermarkeweg 60 Emmen, The Netherlands
5 Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230 Rotterdam, The Netherlands
Critical Care 2010, 14:R164 doi:10.1186/cc9253
Published: 9 September 2010Abstract
Introduction
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.