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Elevation of LDH on admission is often used as a sign of late presentation, however, only few studies evaluated the relationship between LDH elevation and time of presentation. In addition, the impact of elevated LDH before primary PCI on angiographic- and clinical outcome is unknown. A large scale, prospective, observational single-centre study was performed in all consecutive STEMI patients who underwent primary PCI. LDH was measured upon arrival in the PCI centre. Patients who had LDH measurement >1 hour after admission were excluded. The independent association between elevated LDH on admission and 30-day- and 1-year mortality was evaluated using Cox proportionals Hazard models.

Elevated LDH was present in 20.0% of patients. In patients with <150 minutes of symptoms, LDH was elevated in 14.6%. Patients with elevated LDH were older, more often female, had a higher TIMI risk score and Killip class on admission. Elevated LDH on admission was associated with poor angiographic and clinical outcome(TIMI 3 flow post-PCI 85.5%, no-reflow in 14.5%, 30-day mortality 13.5%). At multivariate analyses, elevated LDH on admission remained a strong predictor of 30-day(HR 8.5, CI 95%:5.6–13.0) and 1-year mortality(HR 3.4, CI 95%:2.3–5.0) independent of time from the onset of symptoms.

Elevation of LDH may occur early after the onset of symptoms in STEMI patients who are planned to undergo primary PCI and is associated with poor angiographic and clinical outcome, irrespective of time from symptom onset. Elevated LDH on admission is a strong and independent predictor of short and long-term mortality.