Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction

Martin Frydland*, Jacob Eifer Møller, Sebastian Wiberg, Matias Greve Lindholm, Rikke Hansen, Jose P S Henriques, Ole Kristian Møller-Helgestad, Lia Evi Bang, Ruth Frikke-Schmidt, Jens Peter Goetze, Nanna Louise Junker Udesen, Jakob Hartvig Thomsen, Dagmar M Ouweneel, Laust Obling, Hanne Berg Ravn, Lene Holmvang, Lisette Okkels Jensen, Jesper Kjaergaard, Christian Hassager

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIMS: The diagnosis of cardiogenic shock depends on clinical signs of poor perfusion and low blood pressure. Lactate concentration will increase with poor tissue perfusion, and it has prognostic value in cardiogenic shock patients. We sought to assess the prognostic value of lactate concentration in subjects admitted with suspected ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: In 2,094 (93%) out of 2,247 consecutive suspected STEMI-subjects, lactate concentration was measured on admission. The prognostic value of lactate concentration on 30-day mortality was assessed in addition to clinical signs of peripheral hypoperfusion, systolic blood pressure (sBP), and left ventricular ejection fraction (LVEF) in multivariable models.Lactate concentration added prognostic information beyond signs of peripheral hypoperfusion, sBP, and LVEF, and was independently associated with 30-day mortality (hazard ratio [95% confidence interval] 1.11 [1.07-1.14], P < 0.0001). Lactate also provided predictive information on 30-day mortality to the combination of signs of peripheral hypoperfusion, sBP, and LVEF (area under the receiver-operating characteristics curve = 0.88 vs. 0.83, P < 0.0001). CONCLUSIONS: In conclusion, admission lactate concentration in suspected STEMI-subjects contains prognostic information on 30-day mortality when added to variables used in cardiogenic shock-definition. We recommend lactate measurement in STEMI-subjects, especially when signs of compromised hemodynamics are present.

Original languageEnglish
JournalShock
Volume51
Issue number3
Pages (from-to)321–327
ISSN1073-2322
DOIs
Publication statusPublished - Mar 2019

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Lactic Acid
Cardiogenic Shock
Perfusion
ST Elevation Myocardial Infarction
ROC Curve
Confidence Intervals

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Frydland, Martin ; Møller, Jacob Eifer ; Wiberg, Sebastian ; Lindholm, Matias Greve ; Hansen, Rikke ; Henriques, Jose P S ; Møller-Helgestad, Ole Kristian ; Bang, Lia Evi ; Frikke-Schmidt, Ruth ; Goetze, Jens Peter ; Udesen, Nanna Louise Junker ; Thomsen, Jakob Hartvig ; Ouweneel, Dagmar M ; Obling, Laust ; Ravn, Hanne Berg ; Holmvang, Lene ; Jensen, Lisette Okkels ; Kjaergaard, Jesper ; Hassager, Christian. / Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction. In: Shock. 2019 ; Vol. 51, No. 3. pp. 321–327.
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title = "Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction",
abstract = "AIMS: The diagnosis of cardiogenic shock depends on clinical signs of poor perfusion and low blood pressure. Lactate concentration will increase with poor tissue perfusion, and it has prognostic value in cardiogenic shock patients. We sought to assess the prognostic value of lactate concentration in subjects admitted with suspected ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: In 2,094 (93{\%}) out of 2,247 consecutive suspected STEMI-subjects, lactate concentration was measured on admission. The prognostic value of lactate concentration on 30-day mortality was assessed in addition to clinical signs of peripheral hypoperfusion, systolic blood pressure (sBP), and left ventricular ejection fraction (LVEF) in multivariable models.Lactate concentration added prognostic information beyond signs of peripheral hypoperfusion, sBP, and LVEF, and was independently associated with 30-day mortality (hazard ratio [95{\%} confidence interval] 1.11 [1.07-1.14], P < 0.0001). Lactate also provided predictive information on 30-day mortality to the combination of signs of peripheral hypoperfusion, sBP, and LVEF (area under the receiver-operating characteristics curve = 0.88 vs. 0.83, P < 0.0001). CONCLUSIONS: In conclusion, admission lactate concentration in suspected STEMI-subjects contains prognostic information on 30-day mortality when added to variables used in cardiogenic shock-definition. We recommend lactate measurement in STEMI-subjects, especially when signs of compromised hemodynamics are present.",
author = "Martin Frydland and M{\o}ller, {Jacob Eifer} and Sebastian Wiberg and Lindholm, {Matias Greve} and Rikke Hansen and Henriques, {Jose P S} and M{\o}ller-Helgestad, {Ole Kristian} and Bang, {Lia Evi} and Ruth Frikke-Schmidt and Goetze, {Jens Peter} and Udesen, {Nanna Louise Junker} and Thomsen, {Jakob Hartvig} and Ouweneel, {Dagmar M} and Laust Obling and Ravn, {Hanne Berg} and Lene Holmvang and Jensen, {Lisette Okkels} and Jesper Kjaergaard and Christian Hassager",
year = "2019",
month = "3",
doi = "10.1097/SHK.0000000000001191",
language = "English",
volume = "51",
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issn = "1073-2322",
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Frydland, M, Møller, JE, Wiberg, S, Lindholm, MG, Hansen, R, Henriques, JPS, Møller-Helgestad, OK, Bang, LE, Frikke-Schmidt, R, Goetze, JP, Udesen, NLJ, Thomsen, JH, Ouweneel, DM, Obling, L, Ravn, HB, Holmvang, L, Jensen, LO, Kjaergaard, J & Hassager, C 2019, 'Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction', Shock, vol. 51, no. 3, pp. 321–327. https://doi.org/10.1097/SHK.0000000000001191

Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction. / Frydland, Martin; Møller, Jacob Eifer; Wiberg, Sebastian; Lindholm, Matias Greve; Hansen, Rikke; Henriques, Jose P S; Møller-Helgestad, Ole Kristian; Bang, Lia Evi; Frikke-Schmidt, Ruth; Goetze, Jens Peter; Udesen, Nanna Louise Junker; Thomsen, Jakob Hartvig; Ouweneel, Dagmar M; Obling, Laust; Ravn, Hanne Berg; Holmvang, Lene; Jensen, Lisette Okkels; Kjaergaard, Jesper; Hassager, Christian.

In: Shock, Vol. 51, No. 3, 03.2019, p. 321–327.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Lactate is a Prognostic Factor in Patients Admitted with Suspected ST-Elevation Myocardial Infarction

AU - Frydland, Martin

AU - Møller, Jacob Eifer

AU - Wiberg, Sebastian

AU - Lindholm, Matias Greve

AU - Hansen, Rikke

AU - Henriques, Jose P S

AU - Møller-Helgestad, Ole Kristian

AU - Bang, Lia Evi

AU - Frikke-Schmidt, Ruth

AU - Goetze, Jens Peter

AU - Udesen, Nanna Louise Junker

AU - Thomsen, Jakob Hartvig

AU - Ouweneel, Dagmar M

AU - Obling, Laust

AU - Ravn, Hanne Berg

AU - Holmvang, Lene

AU - Jensen, Lisette Okkels

AU - Kjaergaard, Jesper

AU - Hassager, Christian

PY - 2019/3

Y1 - 2019/3

N2 - AIMS: The diagnosis of cardiogenic shock depends on clinical signs of poor perfusion and low blood pressure. Lactate concentration will increase with poor tissue perfusion, and it has prognostic value in cardiogenic shock patients. We sought to assess the prognostic value of lactate concentration in subjects admitted with suspected ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: In 2,094 (93%) out of 2,247 consecutive suspected STEMI-subjects, lactate concentration was measured on admission. The prognostic value of lactate concentration on 30-day mortality was assessed in addition to clinical signs of peripheral hypoperfusion, systolic blood pressure (sBP), and left ventricular ejection fraction (LVEF) in multivariable models.Lactate concentration added prognostic information beyond signs of peripheral hypoperfusion, sBP, and LVEF, and was independently associated with 30-day mortality (hazard ratio [95% confidence interval] 1.11 [1.07-1.14], P < 0.0001). Lactate also provided predictive information on 30-day mortality to the combination of signs of peripheral hypoperfusion, sBP, and LVEF (area under the receiver-operating characteristics curve = 0.88 vs. 0.83, P < 0.0001). CONCLUSIONS: In conclusion, admission lactate concentration in suspected STEMI-subjects contains prognostic information on 30-day mortality when added to variables used in cardiogenic shock-definition. We recommend lactate measurement in STEMI-subjects, especially when signs of compromised hemodynamics are present.

AB - AIMS: The diagnosis of cardiogenic shock depends on clinical signs of poor perfusion and low blood pressure. Lactate concentration will increase with poor tissue perfusion, and it has prognostic value in cardiogenic shock patients. We sought to assess the prognostic value of lactate concentration in subjects admitted with suspected ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: In 2,094 (93%) out of 2,247 consecutive suspected STEMI-subjects, lactate concentration was measured on admission. The prognostic value of lactate concentration on 30-day mortality was assessed in addition to clinical signs of peripheral hypoperfusion, systolic blood pressure (sBP), and left ventricular ejection fraction (LVEF) in multivariable models.Lactate concentration added prognostic information beyond signs of peripheral hypoperfusion, sBP, and LVEF, and was independently associated with 30-day mortality (hazard ratio [95% confidence interval] 1.11 [1.07-1.14], P < 0.0001). Lactate also provided predictive information on 30-day mortality to the combination of signs of peripheral hypoperfusion, sBP, and LVEF (area under the receiver-operating characteristics curve = 0.88 vs. 0.83, P < 0.0001). CONCLUSIONS: In conclusion, admission lactate concentration in suspected STEMI-subjects contains prognostic information on 30-day mortality when added to variables used in cardiogenic shock-definition. We recommend lactate measurement in STEMI-subjects, especially when signs of compromised hemodynamics are present.

U2 - 10.1097/SHK.0000000000001191

DO - 10.1097/SHK.0000000000001191

M3 - Journal article

VL - 51

SP - 321

EP - 327

JO - Shock

JF - Shock

SN - 1073-2322

IS - 3

ER -