Clinical significance of lactate in acute cardiac patients

Core Tip

Core tip: The present review is focused on the prognostic role of lactate levels in acute cardiac patients (acute coronary syndrome, cardiogenic shock, cardiac arrest). The prognostic impact of hyperlactatemia on mortality has been documented in cardiogenic shock and cardiac arrest even if there is no cut-off value of lactate to be associated with worse outcome or to guide resuscitation or hemodynamic management. Lactate clearance was reported to be clinically more reliable than lactate absolute value in these patients. Despite differences in study design, timing of lactate measurements and type of acute cardiac conditions (i.e., cardiogenic shock, cardiac arrest, refractory cardiac arrest), available evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that a more favorable outcome is observed in patients with higher lactate clearance.