Author + information
- Received April 17, 2020
- Revision received June 8, 2020
- Accepted June 16, 2020
- Published online October 5, 2020.
- Georg Fuernau, MDa,b,∗ (, )@GFurnau,
- Steffen Desch, MDb,c,
- Suzanne de Waha-Thiele, MDa,b,
- Ingo Eitel, MDa,b,
- Franz-Josef Neumann, MDd,
- Marcus Hennersdorf, MDe,
- Stephan B. Felix, MDf,
- Andreas Fach, MDg,
- Michael Böhm, MDh,
- Janine Pöss, MDc,
- Christian Jung, MD, PhDi,
- Taoufik Ouarrak, PhDj,
- Steffen Schneider, PhDj,
- Karl Werdan, MDk,
- Uwe Zeymer, MDj,l and
- Holger Thiele, MDc
- aMedical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Heart Center Lübeck, Lübeck, Germany
- bGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
- cDepartment of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig and Leipzig Heart Institute, Leipzig, Germany
- dDepartment of Cardiology, Bad Krozingen Heart Center, University of Freiburg, Bad Krozingen, Germany
- eDepartment of Internal Medicine I, SLK Kiniken Heilbronn, Heilbronn, Germany
- fDepartment of Internal Medicine B, University of Greifswald, Greifswald, Germany
- gDepartment of Cardiology/Angiology, Klinikum Links der Weser, Bremen, Germany
- hDepartment of Internal Medicine III, University of Homburg, Homburg/Saar, Germany
- iDivision of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
- jInstitut für Herzinfarktforschung, Ludwigshafen, Germany
- kDepartment of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- lMedizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
- ↵∗Address for correspondence:
Dr. Georg Fuernau, University Heart Center Lübeck, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Ratzeburger Allee 160, 23538 Lübeck, Germany.
Objectives This study sought to compare single lactate values at admission (L1) and after 8 h (L2) with lactate clearance (LC) for mortality prediction in cardiogenic shock (CS).
Background Early estimation of prognosis in CS complicating acute myocardial infarction is crucial for tailored treatment selection. Arterial lactate is the most widely used point-of-care parameter in CS. In septic shock, lactate reduction over time—LC—has been extensively investigated. However, in CS, only limited data exist, and the prognostic value of LC is unknown.
Methods This study is a subanalysis of the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock II) trial and the corresponding registry. Lactate levels were prospectively collected. All-cause mortality at 30 days was assessed as primary endpoint.
Results For 671 of 783 (85.7%) patients, L1 and L2 values were available. The area under the receiver-operating characteristic curve (L1: 0.69; L2: 0.76; LC: 0.59) showed no difference between L1 and LC (p = 0.20). In contrast, L2 was a significantly better predictive parameter than L1 or LC (p < 0.001 for both). In multivariable stepwise Cox regression analysis, L2 ≥3.1 mmol/l (best cutoff value by Youden index) and LC <–3.45%/h remained independently predictive for time to death (p < 0.001 for both), with L2 showing the highest chi-square test score (42.1) and hazard ratio (2.89; 95% confidence interval: 2.10 to 3.97).
Conclusions Arterial lactate after 8 h is superior in mortality prediction in comparison with baseline lactate and LC. A cutoff value of 3.1 mmol/l for lactate after 8 h showed the best discrimination for assessing early prognosis in CS and may serve as new treatment goal. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036)
This work is supported by grants from the German Research Foundation (Bonn, Germany), German Heart Research Foundation (Frankfurt, Germany), German Cardiac Society (Düsseldorf, Germany), Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (Berlin, Germany), University of Leipzig Heart Center (Leipzig, Germany), and by unrestricted grants from Maquet Cardiopulmonary (Rastatt, Germany) and Teleflex Medical (Wayne, Pennsylvania). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received April 17, 2020.
- Revision received June 8, 2020.
- Accepted June 16, 2020.
- 2020 American College of Cardiology Foundation
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