Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Nov 2024)

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

  • José Carreras‐Mora,
  • María Vidal‐Burdeus,
  • Clara Rodríguez‐González,
  • Clara Simón‐Ramón,
  • Laura Rodríguez‐Sotelo,
  • Alessandro Sionis,
  • Teresa Giralt‐Borrell,
  • María José Martínez‐Membrive,
  • Andrea Izquierdo‐Marquisá,
  • Núria Farré,
  • Miguel Cainzos‐Achirica,
  • Helena Tizón‐Marcos,
  • Joan García‐Picart,
  • Laia Milà‐Pascual,
  • Beatriz Vaquerizo‐Montilla,
  • Mercedes Rivas‐Lasarte,
  • Núria Ribas‐Barquet

DOI
https://doi.org/10.1161/JAHA.124.035688
Journal volume & issue
Vol. 13, no. 21

Abstract

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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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