CT-detected subclinical pulmonary congestion associated with in-hospital MACE in Killip class 1 STEMI

This retrospective cohort study evaluated 249 Killip class 1 ST-segment elevation myocardial infarction (STEMI) patients who underwent computed tomography (CT) prior to primary percutaneous coronary intervention (PCI). The study assessed the prognostic value of subclinical pulmonary congestion, measured as extravascular lung water (EVLW) by CT, for predicting in-hospital major adverse cardiovascular events (MACE). The comparator was the established GRACE risk score.

Patients who experienced in-hospital MACE had significantly higher GRACE scores (144.96 ± 22.95 vs. 133.63 ± 19.84, P = 0.006) and higher EVLW (24.24% vs. 21.36%, P = 0.001). Adding EVLW measurement to the GRACE score improved the area under the ROC curve from 0.656 to 0.754 (P = 0.045). The net reclassification improvement was 0.491 (P = 0.013) and the integrated discrimination improvement was 0.060 (P = 0.019), indicating significantly improved risk prediction.

Safety and tolerability of the CT scan were not reported. Key limitations include the retrospective, single-center design and the lack of external validation. The study population was limited to Killip class 1 patients, so findings may not generalize to higher Killip classes. The practice relevance is restrained: this is an observational association study that identifies a potential imaging biomarker. It does not establish causality or demonstrate that acting on EVLW findings improves outcomes. The findings suggest CT-assessed EVLW may refine risk stratification, but prospective studies are needed before considering clinical implementation.