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Updated: Jun 6, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Lactate in the acute phase of ST-elevation myocardial infarction treated with mechanical revascularization: a
Chiara Lazzeri1, Serafina Valente, Marco Chiostri
1Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy. lazzeric@libero.it
Insights
Lactate levels predict early mortality in ST-elevation myocardial infarction (STEMI) patients with advanced heart failure (Killip class III-IV). Higher lactate correlates with poorer outcomes and is influenced by hemodynamic impairment and ischemia.
Area of Science:
- Cardiology
- Biochemistry
Background:
- The prognostic significance of lactate in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unclear.
- Early mortality prediction is crucial for managing STEMI patients.
Purpose of the Study:
- To investigate whether lactic acid (LA) levels serve as a prognostic predictor for early mortality in STEMI patients treated with primary PCI.
- To analyze the relationship between LA and other clinical markers in this patient cohort.
Main Methods:
- Retrospective analysis of 807 consecutive STEMI patients admitted to an intensive cardiac care unit (ICCU) between January 2006 and December 2009.
- Assessment of lactate levels and correlation with mortality, ejection fraction, glomerular filtration rate, glucose, troponin I, N-terminal pro-brain natriuretic peptide, uric acid, age, and leukocytes.
Main Results:
- Elevated lactate levels were associated with older age, reduced ejection fraction, and declining renal function.
- Lactate levels correlated positively with glucose, troponin I, and N-terminal pro-brain natriuretic peptide.
- In-hospital mortality was highest in the highest lactate tertile and lactate was an independent predictor of mortality in patients with Killip classes III-IV.
Conclusions:
- Blood lactate is a prognostic marker for early mortality in STEMI patients, specifically in those with advanced Killip class (hemodynamic impairment).
- Lactate concentrations are influenced by the severity of hemodynamic impairment, myocardial ischemia, and glucose levels in the early phase of STEMI.
Aims:
The prognostic role (if any) of lactate for early mortality in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) is so far not elucidated. We therefore assessed whether lactic acid (LA) was a prognostic predictor for early mortality in 807 patients with STEMI submitted to primary PCI consecutively admitted to our intensive cardiac care unit (ICCU) from January 1, 2006, to December 31, 2009.
Result:
Higher levels of LA were found in older patients (P = .025) and were associated with a progressive decline in estimated glomerular filtration rate (P < .001) and in ejection fraction (P < .001). The increase in LA values paralleled the progressive increase in glucose values, peak glycemia, troponin I, N-terminal pro-brain natriuretic peptide, and uric acid (P < .001, P < .001, P < .001, P = .018, and P = .006, respectively). The in-ICCU mortality rate was highest in the third LA tertile (P < .001). Lactate levels were independent predictors for in-hospital mortality only in patients with Killip classes III to IV (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.05-1.30, P = .003). In addition, age (OR, 1.11; 95% CI, 1.03-1.19, P = .006) and leukocytes (OR, 1.17; 95% CI, 1.03-1.33, P = .015) were independent predictors for in-hospital mortality when adjusted for PCI failure.
Conclusion:
In patients with STEMI submitted to primary PCI, blood lactate is a prognostic marker for early mortality only in the subgroup with advanced Killip class. The degree of hemodynamic impairment (as indicated by Killip class), of myocardial ischemia (as inferred by troponin I), and glucose values are the main factors influencing lactate concentrations in the early phase of STEMI.
