Impact on Mortality by Presenting Lactate Level and Lactate Clearance in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock Supported by VA-ECMO and EcPella

Singh, Anmol

Impact on Mortality by Presenting Lactate Level and Lactate Clearance in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock Supported by VA-ECMO and EcPella

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Anmol Singh, MPH , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Andrew Scatola, MD , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Karanbir Singh , New York Institute of Technology, Old Westbury, NY

Navleen Singh , New York Institute of Technology, Old Westbury, NY

AmitKumar Patel, MD, MPH , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Krunalkumar Patel, M.D. , Hofstra Northwell School of Medicine - North Shore University Hospital, Philadelphia, PA

Perwaiz M. Meraj, M.D., FSCAI , Hofstra North Shore-LIJ School of Medicine, Oyster Bay Cove, NY

Background
Current therapies for acute myocardial infarction complicated by cardiogenic shock (AMICS) include use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to provide complete circulatory support. Recent AMICS studies suggest lactate clearance is an important marker of outcomes. We evaluated presenting level and clearance of lactate on survival in an AMICS cohort.

Methods
This was a prospective observational study (2015-2018) in patients with AMICS supported by VA-ECMO or VA-ECMO plus Impella (Abiomed, Danvers, MA). Demographics, presenting lactate and levels at hours 1, 6, 12, 24, 48 and 72 post VA-ECMO initiation were collected. The primary outcome was mortality at 30 days. Secondary outcomes were survival to device explant and discharge.

Results
48 patients were identified; 32 with AMICS were included. Those with normal initial lactates (0-2 mmol/L) had a numerical survival to explant. An elevated presenting lactate (6.1-12 mmol/L ) had worse survival to explant (p 0.05). A normalized lactate at 24 hours post support was associated with improved survival to explant (p < 0.001) and by 48 hours post support it conferred improved survival to explant (p 0.006), discharge (p 0.04) and 30 days (p 0.01).

Conclusions
Patients with early AMICS without an elevated lactate or who quickly normalized their lactate levels, benefited from early mechanical circulatory support, with improved survival. Patients presenting with a moderately elevated lactate level demonstrated worse outcomes and while this was not seen in the group with the highest levels of presenting lactates, this difference is likely due to small sample size.