Admission Bedside Lung Ultrasound Reclassifies Mortality Prediction in Patients With ST-Segment–Elevation Myocardial Infarction. (June 2020)

• Record Type: Journal Article
• Authors: Araujo, Gustavo N.; Silveira, Anderson D.; Scolari, Fernando L.; Custodio, Julia L.; Marques, Felipe P.; Beltrame, Rafael; Menegazzo, Wiliam; Machado, Guilherme P.; Fuchs, Felipe C.; Goncalves, Sandro C.; Wainstein, Rodrigo V.; Leiria, Tiago L.; Wainstein, Marco V.
• Is Part Of: Circulation. Volume 13:Number 6(2020)
• Publication Date: 2020-06
• Subjects: heart failure -- mortality -- myocardial infarction -- percutaneous coronary intervention -- ultrasonography; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.119.010269
• Languages: English
• ISSNs: 1941-9651

Abstract

Abstract : Background: Early risk stratification is essential for in-hospital management of ST-segment–elevation myocardial infarction. Acute heart failure confers a worse prognosis, and although lung ultrasound (LUS) is recommended as a first-line test to assess pulmonary congestion, it has never been tested in this setting. Our aim was to evaluate the prognostic ability of admission LUS in patients with ST-segment–elevation myocardial infarction. Methods: LUS protocol consisted of 8 scanning zones and was performed before primary percutaneous coronary intervention by an operator blinded to Killip classification. A LUS combined with Killip (LUCK) classification was developed. Receiver operating characteristic and net reclassification improvement analyses were performed to compare LUCK and Killip classifications. Results: We prospectively investigated 215 patients admitted with ST-segment–elevation myocardial infarction between April 2018 and June 2019. Absence of pulmonary congestion detected by LUS implied a negative predictive value for in-hospital mortality of 98.1% (93.1–99.5%). The area under the receiver operating characteristic curve of the LUCK classification for in-hospital mortality was 0.89 ( P =0.001), and of the Killip classification was 0.86 ( P <0.001; P =0.05 for the difference between curves). LUCK classification improved Killip ability to predict in-hospital mortality with a net reclassification improvement of 0.18. Conclusions: In a cohort of patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention, admission LUS added to Killip classification was more sensitive than physical examination to identify patients at risk for in-hospital mortality. LUCK classification had a greater area under the receiver operating characteristic curve and reclassified Killip classification in 18% of cases. Moreover, absence of pulmonary congestion on LUS provided an excellent negative predictive value for in-hospital mortality. Abstract : Supplemental Digital Content is available in the text.