Effect of pulmonary artery catheter, type & combination of vasoactives for optimizing lactate clearance in acute myocardial infarction complicated by cardiogenic shock

Introduction

Lactate clearance(LC) is critical in managing critically ill patients. We hypothesized that treatment allocation with different vasoactive drugs or the presence of a pulmonary artery catheter (PAC) could affect the behavior of lactate dynamics and, ultimately, the mortality in AMI-CS.

Materials and methods

In 651 patients with AMI-CS, we examined the relationship of LC time with clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels less than <2 mmol/L. We explore the impact of vasoactive drugs and PAC with LC. The CART method defined the vasoactive combinations (permutations) in relation with early (<96 h) complete LC.

Results

PAC presence correlated with faster LC (−17.54 h) and was independently associated with lower mortality (HR = 0.61). Levosimendan and dobutamine were associated with lower lactate levels and faster LC (−8.82 & -8.77 h), while vasopressin was linked to slower LC (9.16 h). Slow LC (>96 h) was associated with increased mortality. CART analysis identified specific vasoactive drug combinations associated lactate clearance and mortality, without dobutamine, with vasopressin having higher mortality (80.6 %, HR = 5.53), and with dobutamine, with norepinephrine, without vasopressin, with levosimendan the lowest (35 %) and higher complete LC and a trend for higher %LC.

Conclusion

The right combination of vasoactive medications and the probable use of a PAC could significantly impact the achievement of complete LC in <96 h. The findings support the need for further research and the development of strategies to optimize lactate clearance and improve overall patient survival in this high-risk population.