Lung Ultrasound in the Acute Phase of ST-Segment-Elevation Acute Myocardial Infarction: 1-Year Prognosis and
José Carreras-Mora1,2, María Vidal-Burdeus3, Clara Rodríguez-González1
1Department of Cardiology Hospital del Mar Barcelona Spain.
Insights
Lung ultrasound (LUS) can predict major adverse cardiovascular events one year after ST-elevation myocardial infarction. Adding LUS findings to the GRACE score significantly improves risk prediction for these patients.
Area of Science:
- Cardiology
- Medical Imaging
- Critical Care Medicine
Background:
- Lung ultrasound (LUS) is valuable in acute ST-segment-elevation myocardial infarction (STEMI) but its long-term prognostic role is unclear.
- Current risk scores for STEMI do not incorporate LUS findings.
- This study investigates the 1-year prognostic significance of LUS in STEMI patients.
Purpose of the Study:
- To assess the 1-year prognostic value of LUS in STEMI patients.
- To determine if LUS findings can enhance existing risk scores like GRACE.
- To identify LUS as a predictor of major adverse cardiovascular events (MACE).
Main Methods:
- A multicenter prospective cohort study of 373 STEMI patients.
- LUS performed within 24 hours of angiography, assessed categorically (wet/dry lung) and continuously (LUS score).
- Primary endpoint: MACE (all-cause mortality, HF hospitalization, ACS, stroke) within 1 year. GRACE score predictive value assessed with and without LUS.
Main Results:
- 51 patients (13.7%) experienced MACE within 1 year.
- LUS score was an independent predictor of MACE (HR 1.06 per B-line, P=0.009).
- Incorporating LUS into the GRACE score improved prediction (AUC 0.791 vs 0.705, P=0.002) with a net reclassification of 31.6%.
Conclusions:
- LUS B-line detection in the acute phase predicts 1-year MACE in STEMI patients.
- LUS enhances the predictive accuracy of the GRACE score for STEMI outcomes.
- LUS is a valuable tool for risk stratification in STEMI patients.
Background:
Lung ultrasound (LUS) has emerged as a useful tool in the acute phase of patients admitted for ST-segment-elevation myocardial infarction. However, its long-term significance remains uncertain, and risk scores do not include LUS findings as a predictor. This study aims to assess the 1-year prognostic value of LUS and its ability to enhance existing risk scores.
Methods And Results:
This is a multicenter prospective cohort study involving 373 patients with ST-segment-elevation myocardial infarction. LUS was performed during the first 24 hours after angiography. LUS results were assessed both as a categorical (wet/dry lung) and continuous variable (LUS score). The primary end point comprised the following major adverse cardiovascular events: all-cause mortality or hospitalization for heart failure, acute coronary syndrome, or stroke within 1 year. We also evaluated whether LUS could enhance the predictive value of the GRACE (Global Registry of Acute Coronary Events) score. Major adverse cardiovascular events occurred in 51 (13.7%) patients over a median follow-up of 368 days. After multivariate analysis, the LUS score was an independent predictor (hazard ratio [HR], 1.06 [95% CI, 1.01-1.10]; P=0.009] for each additional B-line), whereas the categorical classification was an independent predictor in patients with ST-segment-elevation myocardial infarction Killip I (HR, 3.12 [95% CI, 1.34-7.31]; P=0.009). Incorporating LUS into GRACE resulted in a net reclassification index of 31.6% and a significant increase in the area under the curve; GRACE alone scored 0.705 compared with GRACE+LUS 0.791 (P=0.002).
Conclusions:
Detecting B-lines on LUS at the acute phase predicts major adverse cardiovascular events at 1 year in patients with ST-segment-elevation myocardial infarction and enhances the predictive value of the GRACE score. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04526535.
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