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Blood lactate but not C-reactive protein or white cell count predicts mortality in cardiogenic shock after myocardial infarction
Session:
CO 19 - Cuidados Intensivos
Speaker:
Francisco Gama
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Francisco Fernandes Gama; António Tralhão; Catarina Brízido; Gustavo Mendes; JOANA LIMA; Carlos Aguiar; Jorge Santos Ferreira; Miguel Mendes
Abstract
<p><strong>Background and aim: </strong>there is an ongoing need for risk assessment tools in cardiogenic shock (CS) after acute myocardial infarction (AMI). Previous studies have suggested a role for systemic inflammation in the pathophysiology of CS. We aimed to evaluate the prognostic performance of readily available laboratory variables to predict short-term mortality after CS complicating AMI.</p> <p><strong>Methods: </strong>single-center retrospective cohort study of consecutive AMI patients with cardiogenic shock undergoing revascularization and admitted to a cardiac intensive care unit, between June 2008 and May 2017. Clinical and laboratory variables were collected from the institution's prospective registry. A multivariate regression logistic model was used to determine independent predictors of 1-year all-cause mortality and ROC curve analysis was used to evaluate the model's discriminative power.</p> <p><strong>Results: </strong>in a population of 150 patients, mean age was 67±12 years and 71% (n =107) were male. Most patients presented with STEMI (n =94.5%) and the majority underwent PCI (n=126). All patients had inotropic or vasoconstrictive support, 85.3 % required invasive mechanical ventilation and 59.3 were resuscitated from cardiac arrest. 1-year all-cause mortality occurred in 46 % patients (n=69). Beyond age (OR 1,04 [1.00-1.08], p=0.047), multivariate analysis yielded peak creatinine (OR 1.91 [1.28-2.86], p=0.002) and peak blood lactate (OR 1,27 [1.13-1.43], p<0.001) as the strongest independent predictors of mortality. Neither C-reactive protein nor white-cell count were able to independently predict mortality. Successive addition of each of these variables significantly increased the model's ability to discriminate mortality beyond age alone (Figure).</p> <p><strong>Conclusion:</strong> a simple model containing age, peak creatinine and peak blood lactate achieved good prognostic stratification in our population of AMI patients in CS. Hypoperfusion markers seem to be more helpful than commonly available systemic inflammation markers to discriminate mortality among cardiogenic shock patients.</p>
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