Effect of lactate on the prognosis of patients with acute myocardial infarction and cardiogenic shock supported by extracorporeal membrane oxygenation
Objective To analyze the impact of blood lactate on the prognosis of patients with acute myocardial infarction(AMI)and cardiogenic shock(CS)treated with extracorporeal membrane oxygenation(ECMO),thus guiding clinical practice and improve the prognosis.Methods A retrospective analysis was conducted on the clinical data of AMI patients complicated with CS who were treated with coronary angiography and percutaneous coronary intervention(PCI)under the support of ECMO in the Emergency Medical Department of the Second Hospital of Hebei Medical University from December 2018 to December 2021.All patients underwent the veno-arterial ECMO(VA-ECMO)after a thorough evaluation.Coronary angiography and PCI were performed within 24 hours of onset.During this period,arterial blood lactate levels were measured for multiple times,and the highest lactate level before applying ECMO,the lowest lactate level before emergency PCI after applying ECMO,and lactate clearance rate were recorded.According to the 30-day prognosis,patients were divided into survival group and death group.Changes in blood lactate levels before and after ECMO,and differences in blood lactate levels before and after ECMO between the survival and death groups were compared.The receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of blood lactate levels before and after ECMO on the prognosis of AMI combined with CS.Results Among the 39 patients,21(53.8%)survived and 18(46.2%)died at 30 days of onset.The lowest lactate value after applying ECMO was significantly lower than the highest blood lactate value before applying ECMO(P<0.05).Compared with those of the survival group,the highest blood lactate value before applying ECMO and the lowest lactate value after applying ECMO in the death group were significantly higher,and the lactate clearance rate was significantly lower(P<0.05).ROC curve showed that the highest blood lactate value before applying ECMO and the lowest lactate value after applying ECMO had a predictive value for the prognosis of AMI patients with CS under ECMO support.The area under the curve(AUC)of the highest blood lactate value before applying ECMO was 0.756(95%CI 0.601-0.911,P=0.007).When the cutoff value was 5mmol/L,the sensitivity was 94.1%,and the specificity was 57.1%.AUC of the lowest lactate value after applying ECMO was 0.870(95%CI 0.761-0.979,P=0.000).When the cutoff value was 2.45mmol/L,the sensitivity was 100%and the specificity was 61.9%.Conclusion ECMO can effectively reduce blood lactate levels in AMI patients complicated with CS.The highest blood lactate value before applying ECMO and the lowest blood lactate value after applying ECMO have a predictive value for the prognosis of AMI patients with CS under ECMO support.The highest blood lactate value before applying ECMO of greater than 5mmol/L,and the lowest lactate value before PCI after applying ECMO of greater than 2.45mmol/L indicate a poor prognosis.Reducing blood lactate levels before PCI may improve the prognosis of patients supported by ECMO.
万方数据
维普
