Department of Cardiology, Hospital del Mar, Passeig Marítim de la Barceloneta, 25-29, 08003 Barcelona, Spain.
Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Doctor Aiguader 80, 08003 Barcelona, Spain.
Eur Heart J Acute Cardiovasc Care. 2024 Jul 24;13(7):566-569. doi: 10.1093/ehjacc/zuae073.
The Killip scale remains a fundamental tool for prognostic assessment in ST-segment elevation myocardial infarction (STEMI) due to its simplicity and predictive value. Lung ultrasound (LUS) has emerged as a valuable adjunct for diagnosing and predicting outcomes in heart failure (HF) and STEMI patients, even those with subclinical congestion. We created a new classification (Killip pLUS), which reclassifies Killip I and II patients into an intermediate category (Killip I pLUS) based on LUS results. This category included Killip I patients and ≥1 positive zone (≥3 B-lines) and Killip II with 0 positive zones. We aimed to evaluate this new classification by comparing it with the Killip scale and a previous LUS-based reclassification scale (LUCK scale).
Lung ultrasound was performed within 24 h of admission in a multicentre cohort of 373 patients admitted for STEMI. In-hospital mortality and major adverse cardiovascular events within one year after admission, comprising mortality or readmission for HF, acute coronary syndrome, or stroke, were analysed. When predicting in-hospital mortality, the global comparison of these three classifications was statistically significant: Killip pLUS area under the curve (AUC) 0.90 (95% CI 0.85-0.95) vs. Killip AUC 0.85 (95% CI 0.73-0.96) vs. LUCK 0.83 (95% CI 0.70-0.95), P = 0.024. To predict events during follow-up, the comparison between scales was also significant: Killip pLUS 0.77 (95% CI 0.71-0.85) vs. Killip 0.72 (95% CI 0.65-0.79) vs. LUCK 0.73 (95% CI 0.66-0.81), P = 0.033.
The Killip pLUS scale provides enhanced risk stratification compared to the Killip and LUCK scales while preserving simplicity.
由于其简单性和预测价值，Killip 分级仍然是 ST 段抬高型心肌梗死（STEMI）患者预后评估的基本工具。肺部超声（LUS）已成为心力衰竭（HF）和 STEMI 患者诊断和预测预后的有价值的辅助手段，甚至对亚临床充血的患者也是如此。我们创建了一种新的分类（Killip pLUS），根据 LUS 结果，将 Killip I 和 II 患者重新分类为中间类别（Killip I pLUS）。该类别包括 Killip I 患者和≥1 个阳性区域（≥3 条 B 线）和 Killip II 患者且无阳性区域。我们旨在通过与 Killip 分级和之前基于 LUS 的重新分类分级（LUCK 分级）进行比较来评估这种新的分类。
在一个多中心队列中，对 373 例因 STEMI 入院的患者在入院后 24 小时内进行肺部超声检查。分析入院后 1 年内的院内死亡率和主要不良心血管事件，包括死亡或因 HF、急性冠状动脉综合征或中风再次入院。在预测院内死亡率时，这三种分类的整体比较具有统计学意义：Killip pLUS 的曲线下面积（AUC）为 0.90（95%CI 0.85-0.95），Killip 的 AUC 为 0.85（95%CI 0.73-0.96），LUCK 的 AUC 为 0.83（95%CI 0.70-0.95），P=0.024。为了预测随访期间的事件，各分级之间的比较也具有统计学意义：Killip pLUS 为 0.77（95%CI 0.71-0.85），Killip 为 0.72（95%CI 0.65-0.79），LUCK 为 0.73（95%CI 0.66-0.81），P=0.033。
与 Killip 和 LUCK 分级相比，Killip pLUS 分级提供了更好的风险分层，同时保持了简单性。
