Lung Ultrasound in the Acute Phase of ST-Segment-Elevation Acute Myocardial Infarction: 1-Year Prognosis and Improvement in Risk Prediction

• Published in: Journal of the American Heart Association Vol. 13; no. 21; p. e035688
• Main Authors: Carreras-Mora, José, Vidal-Burdeus, María, Rodríguez-González, Clara, Simón-Ramón, Clara, Rodríguez-Sotelo, Laura, Sionis, Alessandro, Giralt-Borrell, Teresa, Martínez-Membrive, María José, Izquierdo-Marquisá, Andrea, Farré, Núria, Cainzos-Achirica, Miguel, Tizón-Marcos, Helena, García-Picart, Joan, Milà-Pascual, Laia, Vaquerizo-Montilla, Beatriz, Rivas-Lasarte, Mercedes, Ribas-Barquet, Núria
• Format: Journal Article
• Language: English
• Published: England Wiley 29-10-2024
• Subjects: B‐lines; GRACE score; lung ultrasound; STEMI; STEMI; GRACE score; lung ultrasound; B‐lines
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.035688

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.
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];
=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];
=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 (
=0.002).
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.