Predictive value of lung ultrasound combined with ACEF score in patients with acute myocardial infarction

Abstract Objectives Acute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) determines the severity of pulmonary edema by measuring the number of B-lines and has been proved to be of great significance in predicting the poor prognosis of AMI. ACEF (Age, Creatinine, and Ejection Fraction) score has been validated as effective predictor for prognosis in patients undergoing elective cardiac surgery or percutaneous coronary intervention (PCI). However, whether lung ultrasound combined with ACEF score has incremental value in predicting the prognosis of patients with AMI is still unclear. This study aimed to investigate their predictive value in patients with AMI. Methods We performed preoperative echocardiography and LUS in patients with AMI who underwent emergency PCI in our hospital from February 2021 to June 2022，collected clinical data from all patients and conducted ACEF score [ACEF score formula: age/ejection fraction + 1 (if creatinine>176 μmol/L)]. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows: normal (B-line numbers <5), mild (B-line numbers ≥5 and <15), moderate (B-line numbers ≥15 and <30), and severe (B-line numbers ≥30). The adverse events were defined as all-cause death, recurrent myocardial infarction, Myocardial ischemia induced revascularization, and heart failure. Results 224 patients were enrolled, and the average length of hospital stay was 9.71±8.99 days. The ACEF score was positively correlated with the number of B lines (r = 0.43, P<0.01) and NT-proBNP (r =0.66, P<0.01) during hospitalization，The number of B-lines was positively correlated with NT-proBNP (r =0.38, P<0.01). In multivariate Logistic regression analysis, the number of B-lines during hospitalization (OR 1.093 [95%CI: 1.048-1.140], P<0.01) and ACEF score (OR 3.974 [95%CI: 1.680-9.400], P<0.01) were independent predictors of adverse events in AMI patients during hospitalization. For in-hospital results, the area under the receiver operating characteristic curves (AUCs) of ACEF score, LUS and their combination were 0.825 (P<0.01), 0.821(P< 0.01) and 0.880(P<0.01), respectively. 169 patients were followed up for an average of 11.00±6.52 months. In multivariate Cox analysis, the number of B-lines (HR 1.045 [95%CI: 1.023-1.069], P<0.01) and ACEF score (HR 1.649, 95%CI 1.103-2.463, P<0.05) were related with increasing risks of adverse events during follow-up. The area under the AUCs of ACEF score, LUS and their combination were 0.712 (P<0.01), 0.730(P< 0.01) and 0.755(P<0.01), respectively. Conclusions The number of B-lines combined with ACEF score provides incremental value for the risk of adverse events in patients, which is of great significance for risk stratification of patients with AMI.ROC curve during hospitalizationROC curve during follow-up