Mortality in heart failure patients with acute myocardial infarction(AMI) has improved significantly in the last few years. Even so, mortality remains high in patients with impaired hemodynamics and especially in those with cardiogenic shock. Blood lactate is an established prognostic marker in septic shock and overall in intensive care unit patients. This study aims to identify if blood lactate concentration could be used as a prognostic marker in patients presenting with AMI with signs of heart failure but without pronounced hemodynamic impact and absence of hypotension.

1260 patients with with acute myocardial infarctionwho underwent underwent percutaneous coronary interventions were included in this study which was carried out at a Swedish university hospital. The authors evaluated predictors of mortality based on clinical factors from review of patient records.

77 patients (7%) showed signs of heart failure (Killip II-IV) Overall 30-day mortality in patients with Killip class II-IV was 20% (N = 15). In patients classified Killip IV (1%), 30-day mortality was 50% (N = 6). In patients presenting with mild to moderate heart failure (Killlip class II-III), 30-day mortality was 14% (N = 9). In patients with Killip class II-III, lactate ≥2.5 mmol/L was associated with 30-day mortality, whereas systolic blood pressure < 90 mmHg, age, sex and BMI were not. In patients with lactate < 2.5 mmol/L 30-day mortality was 5% (N = 2) whereas mortality was 28% (N = 7) with lactate ≥2.5 mmol/L. This cut-off provided discriminative information on 30-day mortality (area under ROC curve 0.74).

The authors concluded that in patients suffering from acute myocardial infarction, a blood lactate level of over or equal to 2.5 mmol/l may be used as an adjunct in identifying patients with higher risk of short term death, even in the absence of apparent signs of cardiogenic shock and hypotension.

This study was carried out by Grunde Gjesdal, Oscar Ö. Braun, J. Gustav Smith, Fredrik Scherstén and Patrik Tydén and published in 2018 by BMC Cardiovascular Disorders. Gjesdal et al. BMC Cardiovascular Disorders (2018) 18:8

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Blood Lactate is a Predictor of Short-Term Mortality in Patients with Myocardial Infarction
Complicated by Heart Failure but Without Cardiogenic Shock