Killip scale reclassification according to lung ultrasound: Killip pLUS

Area of Science:

• Cardiology
• Critical Care Medicine
• Diagnostic Imaging

Background:

• The Killip scale is essential for assessing ST-segment elevation myocardial infarction (STEMI) prognosis.
• Lung ultrasound (LUS) aids in diagnosing heart failure (HF) and predicting outcomes in STEMI patients, even with subclinical congestion.

Purpose of the Study:

• To evaluate a novel classification, Killip pLUS, which integrates LUS findings into the Killip scale.
• To compare the prognostic performance of Killip pLUS against the standard Killip scale and the LUCK scale.

Main Methods:

• A multicenter cohort of 373 STEMI patients underwent LUS within 24 hours of admission.
• In-hospital mortality and one-year major adverse cardiovascular events (MACE) were analyzed.
• The predictive accuracy of Killip, LUCK, and Killip pLUS scales was compared using area under the curve (AUC).

Main Results:

• Killip pLUS demonstrated superior prediction of in-hospital mortality (AUC 0.90) compared to Killip (AUC 0.85) and LUCK (AUC 0.83).
• For one-year MACE prediction, Killip pLUS (AUC 0.77) also outperformed Killip (AUC 0.72) and LUCK (AUC 0.73).
• Statistical significance was observed in the comparisons between the three scales for both outcomes (P=0.024 for in-hospital mortality, P=0.033 for one-year MACE).

Conclusions:

• The Killip pLUS scale offers enhanced risk stratification for STEMI patients.
• This new classification maintains simplicity while improving prognostic accuracy over existing scales.