Author + information
- Shailendra Singh1,
- Yonathan Litwok1,
- Evelina Grayver1,
- Perwaiz Meraj2,
- Alexander Lee1 and
- Cindy Grines3
The survival of patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) remains low despite early revascularization. The evolving percutaneous mechanical circulatory support (MCS) device options provide the possibility of a brighter future, however markers are needed to assist in therapeutic decision-making when utilizing MCS in AMICS. We investigated if early dynamic changes in lactate levels would reflect the therapeutic benefit of mechanical support and its potential impact on survival in patients presenting with AMICS.
Forty-six patients who presented to our coronary care unit underwent PCI and required MCS with an Impella 2.5 or Impella CP due to AMICS were included in this analysis. Differences between Survivors and Non-Survivors were examined. Results were statistically significant at the p<0.05 level of significance. All performed using SAS version 9.4 (SAS Institute Inc., Cary, NC).
Compared to pre-MCS lactate levels, survival demonstrated a significant decrease of 33.3% in lactate level obtained at 6 hours, where as Non-Survivors had a slight increase in lactate level of 1.8% (p<0.0001)(Figure 1). Patients who had a Lactate Clearance of ≥ 30% at 6 hours were 94% Survivors (p<0.0001)(Figure 2). Earlier MCS implantation was clearly exhibited in the survival group (1.0 hours vs. 21.0 hours, respectively; p<0.0133)(Figure 3). In fact, survival was 82.4% (p<0.0037) when the Impella device was implanted within 2 hours of admission to the hospital.
In conclusion patients who present with AMICS, serial lactate measurements may be used as a prognostic marker and therefore guide therapeutic decision-making. Lack of early improvement of lactic acidosis within six hours after Impella placement in AMICS can be an indication of poor prognosis and therefore possibly inadequate hemodynamic assistance. Our evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that higher lactate clearance is associated with improved survival post Impella placement if done early.
CORONARY: Hemodynamic Support and Cardiogenic Shock