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Updated: May 24, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: a pilot study
Paola Attaná1, Chiara Lazzeri, Marco Chiostri
1Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. paola_md@virgilio.it
Insights
Serial lactate measurements are more reliable for risk stratification. In cardiogenic shock (CS) after ST-elevation myocardial infarction (STEMI), 12-hour lactate clearance less than 10% predicts higher short- and long-term mortality.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Biomarkers
Background:
- Serial lactate measurements offer superior risk stratification compared to single lactate values.
- Cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) presents a high-risk scenario.
- Primary percutaneous coronary intervention (PCI) is a standard treatment for STEMI.
Purpose of the Study:
- To evaluate the predictive value of lactate clearance for early mortality in CS patients post-STEMI treated with primary PCI.
- To identify optimal lactate clearance thresholds for risk stratification.
Main Methods:
- Prospective enrollment of 51 consecutive CS patients post-STEMI.
- Lactate level measurements on admission and at 12 hours in the Intensive Cardiac Care Unit (ICCU).
- Logistic regression, ROC curve analysis, and Kaplan-Meier survival analysis were employed.
Main Results:
- Lactate clearance was significantly higher in survivors at 12 hours (P=0.013).
- Patients with 12-hour lactate clearance <10% exhibited higher in-ICCU mortality (P=0.002).
- A 12-hour lactate clearance <10% was associated with significantly lower long-term survival rates.
Conclusions:
- A 12-hour lactate clearance threshold below 10% identifies CS patients post-STEMI at increased risk of mortality.
- Lactate clearance is a valuable prognostic marker in this high-risk patient population.
- This finding supports the use of serial lactate monitoring for guiding clinical management.
Background:
Recent studies documented that serial lactate measurements over time may be clinically more reliable than lactate absolute value for risk stratification. The aim of the present investigation was to assess the role of lactate clearance in predicting early death in cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI).
Methods:
51 consecutive patients with CS following STEMI were prospectively enrolled. Lactate was measured in Intensive Cardiac Care Unit (ICCU) on admission and on the twelfth hour. Logistic regression analysis was performed to identify the independent predictors for in-ICCU mortality. Receiver operating characteristic (ROC) curve was constructed in order to identify cut-off for admission lactate and for 12-h lactate clearance in relation to in-ICCU mortality. Follow-up survival rate were investigated by Kaplan-Meier curves.
Results:
At 12 h from admission, lactate clearance was higher in survivors (P=0.013). A higher in-ICCU mortality was observed in patients with 12 hours lactate clearance<10% (P=0.002). At follow up, patients with 12-h lactate clearance<10% showed a significantly lower survival rate.
Conclusions:
In patients with CS following STEMI, 12-h lactate clearance<10% identifies a subset of patients at higher risk for death at short and long-term.
