Attaná Paola, Lazzeri Chiara, Chiostri Marco, Picariello Claudio, Gensini Gian Franco, Valente Serafina
Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Acute Card Care. 2012 Mar;14(1):20-6. doi: 10.3109/17482941.2011.655293.
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).
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.
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.
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.
近期研究表明，随着时间推移进行系列乳酸测量对于风险分层而言，在临床上可能比乳酸绝对值更可靠。本研究的目的是评估乳酸清除率在预测接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）后心源性休克（CS）患者早期死亡中的作用。
前瞻性纳入51例STEMI后发生CS的连续患者。在心脏重症监护病房（ICCU）入院时和第12小时测量乳酸水平。进行逻辑回归分析以确定ICCU内死亡的独立预测因素。构建受试者工作特征（ROC）曲线，以确定与ICCU内死亡相关的入院时乳酸水平和12小时乳酸清除率的临界值。通过Kaplan-Meier曲线研究随访生存率。
入院后12小时，幸存者的乳酸清除率更高（P = 0.013）。12小时乳酸清除率<10%的患者观察到更高的ICCU内死亡率（P = 0.002）。在随访中，12小时乳酸清除率<10%的患者显示出显著更低的生存率。
在STEMI后发生CS的患者中，12小时乳酸清除率<10%可识别出短期和长期死亡风险较高的患者亚组。
