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Updated: Apr 18, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Subclinical pulmonary congestion in ST-segment elevation myocardial infarction assessed by computed tomography
Yufan Gao1,2, Keyi Cui2, Shuo Liang2
1Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
Insights
Subclinical pulmonary congestion, measured by CT-derived extravascular lung water (EVLW), predicts in-hospital adverse events in ST-elevation myocardial infarction (STEMI) patients. Adding EVLW to the GRACE score improves risk prediction for major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Radiology
- Critical Care Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) patients with Killip class 1 are considered low-risk, but some experience adverse events.
- Subclinical pulmonary congestion may indicate early cardiac dysfunction.
- Extravascular lung water (EVLW) measured by computed tomography (CT) can quantify pulmonary congestion.
Purpose of the Study:
- To assess the prognostic value of subclinical pulmonary congestion (EVLW via CT) in predicting in-hospital major adverse cardiovascular events (MACE) in Killip class 1 STEMI patients.
- To determine if adding EVLW to the GRACE score improves risk stratification.
Main Methods:
- Retrospective analysis of 249 Killip class 1 STEMI patients undergoing pre-PCI CT.
- EVLW calculated from mean lung density; GRACE score computed.
- In-hospital MACE (mortality, heart failure, shock, arrest, stroke) as the primary endpoint.
- ROC analysis, NRI, and IDI used to evaluate predictive improvement.
Main Results:
- Patients with MACE (n=28) had higher GRACE scores and EVLW compared to those without.
- Adding EVLW to the GRACE score significantly improved AUC (0.754 vs. 0.656, P=0.045).
- Significant improvements in NRI (0.491, P=0.013) and IDI (0.060, P=0.019) were observed.
Conclusions:
- CT-identified subclinical pulmonary congestion (EVLW) is associated with increased in-hospital MACE risk in Killip class 1 STEMI patients.
- EVLW provides incremental prognostic value beyond the GRACE score for risk stratification.
- This finding highlights the importance of assessing pulmonary congestion in STEMI management.
Objectives:
To evaluate the prognostic value of subclinical pulmonary congestion, assessed as extravascular lung water (EVLW) by computed tomography (CT), in ST-segment elevation myocardial infarction (STEMI) patients with Killip class 1.
Methods:
This retrospective study included Killip class 1 STEMI patients who underwent CT prior to primary percutaneous coronary intervention (PCI). EVLW was derived from mean lung density. The Global Registry of Acute Coronary Events (GRACE) score was calculated. The endpoint was in-hospital major adverse cardiovascular events (MACE), defined as all-cause mortality, acute heart failure, cardiogenic shock, resuscitated cardiac arrest, or stroke. The predictive improvement of adding EVLW to the GRACE score was assessed using receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Results:
Among 249 patients (mean age 59 ± 11 years; 195 men), 28 experienced MACE. Patients with MACE had a higher GRACE score (144.96 ± 22.95 vs. 133.63 ± 19.84, P = 0.006) and EVLW (24.24% vs. 21.36%, P = 0.001). Adding EVLW to the GRACE score significantly increased the area under the ROC curve (AUC) (0.754 vs. 0.656, P = 0.045), NRI (0.491, P = 0.013), and IDI (0.060, P = 0.019).
Conclusions:
In Killip class 1 STEMI patients, CT-identified subclinical pulmonary congestion is associated with an increased risk of in-hospital MACE.
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