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Published on: June 12, 2021
Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock
Serafina Valente1, Chiara Lazzeri, Sabine Vecchio
1Coronary Care Unit, Heart and Vessel Department, Viale Morgagni 85, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy. seravalente@hotmail.com <seravalente@hotmail.com>
Insights
High mortality in cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) is linked to elevated lactate levels. Hyperlactatemia on admission independently predicts in-hospital death in these critical patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Biochemistry
Background:
- Cardiogenic shock (CS) complicating ST-elevation myocardial infarction (STEMI) carries a high mortality rate, even with timely revascularization.
- Understanding CS pathophysiology has evolved beyond hemodynamics to include metabolic dysregulation.
- Predictors of mortality in CS post-STEMI require further elucidation.
Purpose of the Study:
- To identify predictors of in-hospital mortality in patients with CS complicating STEMI.
- To investigate the role of serum lactate, glucose, and uric acid levels in predicting outcomes.
Main Methods:
- A cohort of 45 consecutive patients with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) was studied.
- Serum levels of lactate, glucose, and uric acid were measured upon coronary care unit (CCU) admission.
- In-hospital death was the primary endpoint.
Main Results:
- Univariate predictors of mortality included elevated glucose, creatinine, uric acid, lactate, older age, hypertension, and poor TIMI flow post-PCI.
- Multivariate analysis identified hyperlactatemia (>6.5 mmol/l) and TIMI flow post-PCI ≤2 as independent predictors of in-hospital death.
- Hyperlactatemia showed a significantly higher odds ratio (OR=295, p=0.01) for mortality.
Conclusions:
- Hyperlactatemia, hyperglycemia, and elevated uric acid are univariate predictors of in-hospital death in CS patients post-STEMI.
- Hyperlactatemia (>6.5 mmol/l) emerges as a robust, independent predictor of in-hospital mortality in this high-risk population.
- These metabolic markers can aid in risk stratification and management decisions.
Objectives:
The mortality of patients with cardiogenic shock (CS) complicating ST elevation acute myocardial infarction (STEMI) remains high, despite early revascularization. Current knowledge of predictors of death is limited.
Background:
The pathophysiologic understanding of CS after acute myocardial infarction has shifted from a mere hemodynamic disorder to a more complex approach including imbalance in metabolic functions.
Methods:
In 45 consecutive patients (71.4+/-13 years) with CS complicating STEMI treated with primary percutaneous coronary intervention (PCI) serum levels of lactate, glucose and uric acid on coronary care unit (CCU) admission were measured. The end-point was in-hospital death.
Results:
The following parameters, on CCU admission, were univariate predictors of in-hospital mortality: serum glucose >200 mg/dl (OR=11.3, p=0.002), serum creatinine >1.5 mg/dl (OR=12.7, p=0.003), uric acid >6.5 mg/dl (OR=6.7, p=0.016), lactate >6.5 mmol/l (OR=54, p<0.0001), age > or =75 years (OR=8.5, p=0.002), history of hypertension (OR=8.3, p=0.003) and TIMI flow post PCI < or = 2 (OR=12.9, p=0.02). At multivariate analysis, after adjustment for sex, age, hypertension and diabetes, lactate >6.5 mmol/l and TIMI flow post PCI < or = 2 were still independent predictors of in-hospital mortality (OR=295, p=0.01; OR=19.5, p=0.04, respectively).
Conclusions:
Hyperlactatemia, hyperglycemia and increased levels of uric acid on CCU admission are univariate predictors of in-hospital death. Moreover, at multivariate analysis, hyperlactatemia (>6.5 mmol/l) is an independent indicator of in-hospital death in CS patients complicating STEMI.
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