Abstract
Impact of tissue lactate accumulation on prognosis after acute myocardial infarction (AMI) is biased. The study aimed to assess the prognostic role of lactate concentration (LC) in patients with AMI during one year of follow-up. 145 consecutive patients admitted due to AMI were enrolled. The data on the frequency of endpoint occurrence (defined as I, death; II, heart failure (HF); and III, recurrent myocardial infarction (re-MI)) were collected. The patients were divided into group A (LC below the cut-off value) and group B (LC above the cut-off value) for the endpoints according to receiver operating characteristic (ROC) analysis. The cumulative survival rate was 99% in group I-A and 85% in group I-B (p = 0.0004, log-rank test). The HF-free survival rate was 95% in group II-A and 82% in group II-B (p = 0.0095, log-rank test). The re-MI-free survival rate did not differ between groups. A multivariate Cox analysis showed a statistically significant influence of LC on death [Hazard Ratio (HR): 1.41, 95% Confidence Interval (CI) (1.13–1.76), and p = 0.002] and HF [HR: 1.21, 95% CI (1.05–1.4), and p = 0.007] with no impact on re-MI occurrence. LC in capillary blood may be considered a useful prognostic marker of late-onset heart failure and death after AMI.
Highlights
Cardiovascular diseases are the most common cause of death in Poland, with an annual death rate of 452 per 100,000
Patients received typical treatment according to the current European Society of Cardiology (ESC) guidelines, which were independent of the results of the lactate concentration (LC) measurement and were submitted for revascularization via percutaneous coronary intervention (PCI) coronary artery bypass grafts (CABG) or optimal medical therapy (OMT) either ad hoc or after a heart team decision process
The enrolled patients were subsequently analyzed according to the defined endpoints, which included death, heart failure (HF), and recurrent myocardial infarction (re-MI) occurrence in one year of follow-up performed in the majority of cases during clinical examination (90%) or telephone survey (10%)
Summary
Cardiovascular diseases are the most common cause of death in Poland, with an annual death rate of 452 per 100,000. Irrespective of a broad spectrum of activities, a further decrease in the mortality rate primarily depends on innovation in pharmacotherapy and primary percutaneous coronary intervention (PCI) delay shortening. Patient-dependent delay plays a crucial role in the potential improvement of AMI treatment results; there is a need for the implementation of an easy-touse and cost-effective diagnostic and prognostic tool. AMI is associated with an anaerobic switch phenomenon, which is primarily due to coronary artery occlusion, leading to the acute impairment of myocardium oxygen supply. A deterioration in left ventricle contractility leading to a reduction in cardiac output may result in peripheral tissue hypoxemia and inhibit glycolysis, which represents the primary source of adenosine triphosphate (ATP) supply, providing thirtyeight moles of ATP from one molecule of glucose.
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