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The following is a summary of “Effect of pulmonary artery catheter, type & combination of vasoactives for optimizing lactate clearance in acute myocardial infarction complicated by cardiogenic shock,” published in the April 2025 issue of Journal of Critical Care by Ortega-Hernández et al. 

Researchers conducted a retrospective study to analyze how treatment allocation with different vasoactive drugs and the presence of a pulmonary artery catheter (PAC) influenced lactate dynamics and mortality in AMI-CS.  

They analyzed data from 651 patients with AMI-CS to examine the relationship between lactate clearance (LC) time and clinical, laboratory, and CS-management variables. Complete LC time was defined as serum lactate levels below 2 mmol/L. The study explored the influence of vasoactive drugs and the presence of PAC on LC. The CART method was used to identify vasoactive drug combinations (permutations) associated with early (<96 hours) complete LC.  

The results showed that the presence of a PAC was associated with faster LC (−17.54 hours) and lower mortality (HR = 0.61). Levosimendan and dobutamine were related to faster LC (−8.82 and −8.77 hours, respectively), while vasopressin was associated with slower LC (9.16 hours). Slow LC (>96 hours) correlated with higher mortality. The CART analysis identified specific vasoactive drug combinations: without dobutamine, vasopressin was linked to higher mortality (80.6%, HR = 5.53); with dobutamine and norepinephrine (without vasopressin), levosimendan had the lowest mortality (35%) and higher LC.  

Investigators concluded that the optimal combination of vasoactive medications and the potential use of a PAC significantly impacted achieving complete LC in less than 96 hours. 

Source: sciencedirect.com/science/article/abs/pii/S0883944124004775