INTRODUCTION: Cardiogenic shock complicating acute myocardial infarction has a very high mortality. Our present study focuses on serial measurement of lactate during admission due to cardiogenic shock and the prognostic effect of lactate and a relative change in lactate in patients after admission and the institution of intensive care treatment. METHODS AND RESULTS: This is a secondary analysis of the CardShock study. Data on lactate at baseline were available on 217 of 219 patients.In the study population, the median baseline lactate was 2.8 mmol/L (min-max range, 0.5-23.1 mmol/L).At admission, lactate was predictive of 30-day mortality with an adjusted Hazard ratio (HR) of 1.20 mmol/L (95% confidence interval, CI 1.14-1.27). Within the first 24 h of admission, baseline lactate remained predictive of 30-day mortality. Lactate at 6 h had a HR of 1.14 (95% CI 1.06-1.24) and corresponding values at 12 and 24 h had a HR of 1.10 (1.04-1.17), and of HR 1.19 (95% CI 1.07-1.32), respectively. A 50% reduction in lactate within 6 h resulted in a HR of 0.82 (95% CI 0.72-0.94). Corresponding hazard ratios at 12 and 24 h, were 0.87 (95% CI 0.76-0.98) and 0.74 (95% CI 0.60-0.91), respectively. CONCLUSION: The main findings of the present study are that baseline lactate is a powerful predictor of 30-day mortality, lactate at 6, 12, and 24 h after admission are predictors of 30-day mortality, and a relative change in lactate is a significant predictor of survival within the first 24 h after instituting intensive care treatment adding information beyond the information from baseline values.

Cardiology Department Universidad Autónoma de Barcelona Intensive Cardiac Care Unit Hospital de la Santa Creu i Sant Pau Biomedical Research Institute IIB SantPau Spain

Department of Anesthesiology Critical Care and Burn Unit University Paris Diderot Sorbonne Paris Cité Paris France

Department of Cardiology Heart and Lung Center Helsinki University Hospital Finland

Department of Cardiology São João Hospital Center University of Porto CINTESIS Porto Medical School Portugal

Department of Cardiology University Hospital Copenhagen Rigshospitalet Denmark

Department of Emergency Care Helsinki University Hospital Helsinki University Helsinki Finland

Department of Emergency Medicine and Services Helsinki University Hospital Helsinki Finland

Department of Emergency Medicine Sant' Andrea Hospital Rome Italy

Department of Internal Medicine and Cardiology University Hospital Brno Czech Republic

Department of Medical and Surgical Specialties Radiological Sciences and Public Health University and Civil Hospital of Brescia Division of Cardiology Italy

University Hospital Athens ER and Heart Failure Unit Attikon Greece

University Hospital Warsaw Institute of Cardiology Intensive Cardiac Therapy Clinic Poland

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Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction