Admission Bedside Lung Ultrasound Reclassifies Mortality Prediction in Patients With ST-Segment-Elevation Myocardial...

Area of Science:

• Cardiology
• Medical Imaging
• Critical Care Medicine

Background:

• Early risk stratification is crucial for managing ST-segment-elevation myocardial infarction (STEMI).
• Acute heart failure significantly worsens prognosis in STEMI patients.
• Lung ultrasound (LUS) is recommended for assessing pulmonary congestion but its prognostic value in STEMI is unestablished.

Purpose of the Study:

• To evaluate the prognostic capability of admission Lung Ultrasound (LUS) in patients with ST-segment-elevation myocardial infarction (STEMI).
• To develop and validate a novel risk stratification tool combining LUS and Killip classification for STEMI patients.

Main Methods:

• A prospective study of 215 STEMI patients undergoing primary percutaneous coronary intervention.
• Lung ultrasound (LUS) was performed in 8 zones by a blinded operator before intervention.
• A LUS combined with Killip (LUCK) classification was developed and compared to Killip classification using ROC and net reclassification improvement analyses.

Main Results:

• Absence of pulmonary congestion on LUS had a 98.1% negative predictive value for in-hospital mortality.
• The LUCK classification demonstrated a higher area under the ROC curve (0.89) for in-hospital mortality compared to Killip classification (0.86).
• LUCK classification showed a 0.18 net reclassification improvement over Killip classification, indicating enhanced predictive accuracy.

Conclusions:

• Admission LUS, when added to Killip classification, is more sensitive than physical examination for identifying STEMI patients at risk of in-hospital mortality.
• The LUCK classification offers superior prognostic ability compared to the Killip classification alone.
• LUS is a valuable tool for risk stratification in STEMI, particularly in ruling out mortality risk when pulmonary congestion is absent.