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- Vermeulen, Robert P, et al.
(författare)
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Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction at admission : a descriptive study
- 2010
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 14:5, s. R164-
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT : INTRODUCTION : Blood lactate measurements can be used as an indicator of hemodynamic impairment and relate to mortality in various forms of shock. Little is known at the moment concerning the clinical correlates of systemic lactate in patients with ST-segment elevation myocardial infarction (STEMI). METHODS : To assess the relation of systemic arterial lactate levels in STEMI patients with clinical correlates at presentation in the catheterization laboratory, we measured arterial lactate levels with a rapid point-of-care technique, immediately following femoral sheath insertion. The study population (n= 1,176) was divided into tertiles with lactate levels ≤1.1 (n = 410), 1.2 to 1.7 (n = 398) and ≥1.8 mmol/l (n = 368). We compared both baseline characteristics and outcome measures of the three lactate groups. RESULTS : Factors independently associated with higher lactate levels were hypotension, heart rate, thrombolysis in myocardial infarction (TIMI) flow 0 to 1, diabetes and non-smoking. Mortality at 30 days in the three groups was 2.0%, 1.5% and 6.5%. The latter group also showed lower blush grades and greater enzymatic infarct sizes. An intra aortic balloon pump (IABP) was used more frequently in patients with higher lactate levels (4.2%, 7.6% and 14.7%). CONCLUSIONS : In STEMI patients, impaired hemodynamics, worse TIMI flow and non-smoking were related to increased arterial lactate levels. Higher lactate levels were independently related with 30-day mortality and an overall worse response to percutaneous coronary intervention (PCI). In particular, acute mortality was related to admission lactates ≥1.8 mmol/L. Point-of-care measurement of arterial lactate at admission in patients with STEMI has the potential to improve acute risk stratification.
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| 2. |
- Vermeulen, Robert P, et al.
(författare)
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Clinical performance indicators for percutaneous coronary intervention.
- 2008
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Ingår i: Critical Pathways in Cardiology. - 1535-282X .- 1535-2811. ; 7:2, s. 126-32
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Tidskriftsartikel (refereegranskat)abstract
- Quality indicators in cardiology can be used to guide performance at a patient level, or at an organizational level. To positively influence adherence to performance guidelines, policymakers have to ensure that employees are involved in the development of guidelines and indicators. The first phase for selecting performance measures is creating a set of performance indicators. The aim of this study was to identify performance indicators with a high degree of consensus among professionals in daily practice for interventional cardiology. Each of the 50 predefined performance indicators was rated by 17 cardiologists and 17 head nurses (one from each participating center) on a 5-point scale. The cluster of indicators with the highest scores was resubmitted to the participants of the first phase for verification. After the second phase, performance indicators with >90% positive score for inclusion were qualified as key performance indicator (KPI). In the first phase, 24 of 34 response forms were returned (71%). Performance indicators with the highest overall mean scores were complications (4.71), in-hospital delay for patients with acute myocardial infarction (4.67), mortality (4.63), technical result (4.42), and patient satisfaction (4.38). The scores of cardiologists and nurses showed similar patterns. Nineteen indicators were selected for verification. After the second phase, 8 indicators qualified as KPI: complications, data flow, in-hospital delay, frequency of heart team meetings, number of procedures per center, mortality, restenosis rate, and use of protocols. The 8 KPI are both quantifiable and aimed at the catheterization laboratory as a unit.
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