Diagnostic Performance of Venous Lactate on Arrival at the Emergency Department for Myocardial Infarction
Bibliographic record
Abstract
OBJECTIVES: To determine the sensitivity of the venous lactate level at presentation for acute myocardial infarction (AMI) in emergency department (ED) patients with chest pain. METHODS: A prospective, double-blind observational study was done in a tertiary care ED. From January to April 2000, all consecutive patients presenting with chest pain were eligible. Lactate level was obtained on arrival and compared with two criterion standards for the diagnosis of AMI: the World Health Organization (WHO) and the Joint European Society of Cardiology/American College of Cardiology Committee (ESC/ACC) classifications. A lactate level greater than 1.50 mmol/L was considered positive. RESULTS: Between January and April 2000, 718 patients were enrolled. By the WHO criteria, 64 patients suffered an AMI, of whom 59 had an elevated lactate level, yielding a sensitivity of 92% (95% CI = 86% to 99%), a specificity of 44% (95% CI = 40% to 48%), and a negative predictive value (NPV) of 98% (95% CI = 97% to 99%). For all patients presenting with more than two hours of chest pain (n=34), the lactate level was elevated. When using the ESC/ACC criteria, 100 patients sustained an AMI, of whom 88 had an elevated lactate level, yielding a sensitivity of 88% (95% CI = 82% to 94%), a specificity of 46% (95% CI = 42% to 50%), and an NPV of 96% (95% CI = 94% to 98%). CONCLUSIONS: Venous lactate level at presentation is highly sensitive for the diagnosis of AMI, particularly in patients with more than two hours of chest pain. Given its limitations in specificity and ability to detect creatine kinase-MB-negative/troponin-positive microinfarcts, further research is needed to determine how lactate can complement other cardiac enzymes in risk-stratifying all acute coronary syndromes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".