Subclinical pulmonary congestion in ST-segment elevation myocardial infarction assessed by computed tomography

Objectives To evaluate the prognostic value of subclinical pulmonary congestion, assessed as extravascular lung water (EVLW) by computed tomography (CT), in ST-segment elevation myocardial infarction (STEMI) patients with Killip class 1. Methods This retrospective study included Killip class 1 STEMI patients who underwent CT prior to primary percutaneous coronary intervention (PCI). EVLW was derived from mean lung density. The Global Registry of Acute Coronary Events (GRACE) score was calculated. The endpoint was in-hospital major adverse cardiovascular events (MACE), defined as all-cause mortality, acute heart failure, cardiogenic shock, resuscitated cardiac arrest, or stroke. The predictive improvement of adding EVLW to the GRACE score was assessed using receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results Among 249 patients (mean age 59 ± 11 years; 195 men), 28 experienced MACE. Patients with MACE had a higher GRACE score (144.96 ± 22.95 vs. 133.63 ± 19.84, P = 0.006) and EVLW (24.24% vs. 21.36%, P = 0.001). Adding EVLW to the GRACE score significantly increased the area under the ROC curve (AUC) (0.754 vs. 0.656, P = 0.045), NRI (0.491, P = 0.013), and IDI (0.060, P = 0.019). Conclusions In Killip class 1 STEMI patients, CT-identified subclinical pulmonary congestion is associated with an increased risk of in-hospital MACE.