Department of Cardiology Hospital del Mar Barcelona Spain.
Department of Medicine and Life Sciences Universitat Pompeu Fabra Barcelona Spain.
J Am Heart Assoc. 2024 Nov 5;13(21):e035688. doi: 10.1161/JAHA.124.035688. Epub 2024 Oct 29.
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.
肺部超声（LUS）已成为 ST 段抬高型心肌梗死患者急性期的有用工具。然而，其长期意义尚不确定，风险评分并未将 LUS 结果作为预测因子纳入其中。本研究旨在评估 LUS 的 1 年预后价值及其增强现有风险评分的能力。
这是一项多中心前瞻性队列研究，纳入了 373 例 ST 段抬高型心肌梗死患者。在血管造影后 24 小时内进行 LUS 检查。将 LUS 结果作为分类变量（湿/干肺）和连续变量（LUS 评分）进行评估。主要终点包括以下主要不良心血管事件：1 年内全因死亡率或因心力衰竭、急性冠状动脉综合征或中风住院。我们还评估了 LUS 是否可以增强 GRACE（全球急性冠状动脉事件注册）评分的预测价值。中位随访 368 天期间，51 例（13.7%）患者发生主要不良心血管事件。多变量分析后，LUS 评分是独立预测因子（危险比 [HR]，1.06 [95%CI，1.01-1.10]；=0.009，每增加 1 条 B 线），而在 ST 段抬高型心肌梗死 Killip I 患者中，分类是独立预测因子（HR，3.12 [95%CI，1.34-7.31]；=0.009）。将 LUS 纳入 GRACE 后，净重新分类指数为 31.6%，曲线下面积显著增加；GRACE 单独评分为 0.705，GRACE+LUS 评分为 0.791（=0.002）。
在 ST 段抬高型心肌梗死患者急性期检测 LUS 上的 B 线可预测 1 年内的主要不良心血管事件，并增强 GRACE 评分的预测价值。
