Role of Lactic Acid as Predictor of Mortality in Patients with Acute Myocardial Infarction

Novi Khila Firani, Theresa Sugiarti Oetji


The hypoxic-ischemic condition causes tissue metabolic abnormalities and organ dysfunction, characterized by
elevated blood lactic acid levels. It is suspected that increased lactic acid in Acute Myocardial Infarction (AMI) patients could
increase mortality risk. This study aimed to determine whether increased lactic acid levels could be used as a predictor of
mortality in AMI patients. The analytical observational-cohort study was performed on AMI patients who were admitted to
Dr. Saiful Anwar Malang Hospital from January 2018 to December 2019. Research subjects were divided into two groups, the
group of deceased and living AMI patients, who were tested for lactic acid, troponin-I, CKMB, and creatinine levels at
admission. Diabetes mellitus and septic patients were excluded. For analysis of lactic acid as a predictor of mortality, ROC
curve analysis and odds ratio were used. There found that lactic acid levels in the deceased AMI patients group were higher
compared to that of the living AMI patients (p < 0.05). The sensitivity and specificity values of lactic acid as a predictor of
mortality in AMI patients at a cut-off of 3.5 mmol/L were 66.7% and 80%, respectively. Odds ratio analysis showed that AMI
patients with lactic acid levels more than 3.5 mmol/L had 8 times greater mortality risk than those whose level less than 3.5
mmol/L. It was concluded that lactic acid level can be used as an indicator to predict the mortality of AMI patients.


Lactic acid, predictor, mortality, acute myocardial infarction

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Ministry of Health (Indonesia). Indonesia sample

registration system [Internet]. 2014. Available from:

h t t p : / / g h d x . h e a l t h d a t a . o r g / r e c o r d /


(accessed 2 Sept, 2003).

Badan Penelitian dan Pengembangan Kesehatan

Kementrian Kesehatan RI. Riset kesehatan dasar. 2013;


World Health Organization. World Health Statistics

[Internet]. 2012. Available from: https://apps.


FFB3CB0A9?sequence=1 (accessed 2 Sept, 2003).

Kementrian Kesehatan RI. Penyakit jantung penyebab

kematian tertinggi, Kemenkes ingatkan CERDIK

[Internet]. 2017. Available from: http://sehatnegeriku.


-kemenkes-ingatkan-cerdik/ (accessed 2 Sept, 2003).

th 5. Goldman L. Cecil medicine. 25 Ed., Philadelphia,

Saunders Elsevier, 2016; 432-41.

Winchester DE, Kline K, Estel C, Mahtta D, Taasan S,

Peacock FW. Associations between cardiac troponin,

mortality and subsequent use of cardiovascular

services: Differences in sex and ethnicity. Open Hear,

; 5(1): 1-7.

Fanola CL, Morrow DA, Cannon CP, Jarolim P, Lukas

MA, Bode C, et al. Interleukin-6 and the risk of adverse

outcomes in patients after an acute coronary

syndrome: Observations from the SOLID-TIMI 52

(stabilization of plaque using darapladib-thrombolysis

in myocardial infarction 52) trial. J Am Heart Assoc,

; 6(10): 1-10.

Carvalho G, Rassi S. The prognostic value of CK-MB in

acute myocardial infarction in developing countries: A

descriptive study. Angiol Open Access, 2016; 4(3): 1-7.

Cakar MA, Gunduz H, Vatan MB, Kocayigit I, Akdemir

R. The effect of admission creatinine levels on

one-year mortality in acute myocardial infarction. Sci

World J, 2012; (July 2009): 1-5.

Pan W, Lu H, Lian B, Liao P, Guo L, Zhang M. Prognostic

value of HbA1c for in-hospital and short-term

mortality in patients with acute coronary syndrome: A

systematic review and meta-analysis. Cardiovasc

Diabetol [Internet]. 2019; 18(1): 1-12. Available from:

(accessed 12 October, 2019).

Villar J, Short JH, Lighthall G. Lactate predicts both

short- and long-term mortality in patients with and

without sepsis. Infect Dis Res Treat, 2019; 12: 1-6.

th 12. Murray R. Harper's illustrated biochemistry. 27 Ed.,

United States of America, McGraw-Hill Companies,

; 136-44 .

Yu H, Wang Q, Li X, Ma J, Li J, Hu H, et al. Case Report

ST-segment elevation in a patient with myocardial

infarction after primary PCI due to cardiogenic shock,

hyperkalemia, and acidosis. Int J Clin Exp Med, 2018; 11.

Hai JJ, Tam E, Chan PH, Lau CP, Siu CW, Tse HF.

Incidence and predictors of sudden arrhythmic death

or ventricular tachyarrhythmias after acute coronary

syndrome: An asian perspective. Hear Rhythm

[Internet]. 2017; 14(1): 81-7. Available from: j.hrthm.2016.09.011

(accessed 20 October, 2019).

Savonitto S, Ferri LA, Colombo D. Perimenopause

vasomotor symptoms, coronary atherosclerosis and

risk of myocardial infarction during menopause: The

cardiologist's perspective. Prz Menopauzalny, 2018;

(2): 53-6.

Sze J, Mooney J, Barzi F, Hillis GS, Chow CK. Cardiac

troponin and its relationship to cardiovascular outcomes

in community populations - a systematic review and

meta-analysis. Hear Lung Circ [Internet]. 2016; 25(3):

-28. Available from:

j.hlc.2015.09.001 (accessed 25 October, 2019).

McPherson R. Henry's clinical diagnosis and

management by laboratory methods. Missouri,

Elsevier, 2017; 244-52.

Dumaine R, Collet JP, Tanguy ML, Mansencal N,

Dubois-Randé JL, Henry P, et al. Prognostic

significance of renal insufficiency in patients

presenting with acute coronary syndrome (the

prospective multicenter SYCOMORE study). Am J

Cardiol, 2004; 94(12): 1543-7.

Zhao L, Wang L ZY. Elevated admission serum

creatinine predicts poor myocardial blood flow and

one-year mortality in ST-segment elevation

myocardial infarction patients undergoing primary

percutaneous coronary intervention. J Invasive Cardiol

[Internet]. 2009; 21(10): 493-8. Available from: article/med/19805833

(accessed 12 November, 2019).

Al Suwaidi J, Reddan DN, Williams K, Pieper KS,

Harrington RA, Califf RM, et al. Prognostic implications

of abnormalities in renal function in patients with

acute coronary syndromes. Circulation, 2002; 106(8):


Frydland M, Møller JE, Wiberg S, Lindholm MG,

Hansen R, Henriques JPS, et al. Lactate is a prognostic

factor in patients admitted with suspected st-elevation

myocardial infarction. Shock, 2019; 51(3): 321-7.

Vermeulen RP, Hoekstra M, Nijsten MWN, van der Horst

IC, van Pelt LJ, Jessurun GA, et al. Clinical correlates of

arterial lactate levels in patients with ST-segment

elevation myocardial infarction at admission: A

descriptive study. Crit Care, 2010; 14(5): 1-7.



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