Killip scale reclassification according to lung ultrasound: Killip pLUS.

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-07-24 DOI:10.1093/ehjacc/zuae073
José Carreras-Mora, María Vidal-Burdeus, Clara Rodríguez-González, Clara Simón-Ramón, Laura Rodríguez-Sotelo, Alessandro Sionis, Teresa Giralt-Borrell, María José Martínez-Membrive, Andrea Izquierdo-Marquisá, Miguel Cainzos-Achirica, Beatriz Vaquerizo-Montilla, Mercedes Rivas-Lasarte, Núria Ribas-Barquet
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Abstract

Aims: The Killip scale remains a fundamental tool for prognostic assessment in ST-segment elevation myocardial infarction (STEMI) due to its simplicity and predictive value. Lung ultrasound (LUS) has emerged as a valuable adjunct for diagnosing and predicting outcomes in heart failure (HF) and STEMI patients, even those with subclinical congestion. We created a new classification (Killip pLUS), which reclassifies Killip I and II patients into an intermediate category (Killip I pLUS) based on LUS results. This category included Killip I patients and ≥1 positive zone (≥3 B-lines) and Killip II with 0 positive zones. We aimed to evaluate this new classification by comparing it with the Killip scale and a previous LUS-based reclassification scale (LUCK scale).

Methods and results: Lung ultrasound was performed within 24 h of admission in a multicentre cohort of 373 patients admitted for STEMI. In-hospital mortality and major adverse cardiovascular events within one year after admission, comprising mortality or readmission for HF, acute coronary syndrome, or stroke, were analysed. When predicting in-hospital mortality, the global comparison of these three classifications was statistically significant: Killip pLUS area under the curve (AUC) 0.90 (95% CI 0.85-0.95) vs. Killip AUC 0.85 (95% CI 0.73-0.96) vs. LUCK 0.83 (95% CI 0.70-0.95), P = 0.024. To predict events during follow-up, the comparison between scales was also significant: Killip pLUS 0.77 (95% CI 0.71-0.85) vs. Killip 0.72 (95% CI 0.65-0.79) vs. LUCK 0.73 (95% CI 0.66-0.81), P = 0.033.

Conclusion: The Killip pLUS scale provides enhanced risk stratification compared to the Killip and LUCK scales while preserving simplicity.

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根据肺部超声对 Killip 分级进行重新分类:Killip pLUS。
目的:基利普量表因其简便性和预测价值,仍是 ST 段抬高型心肌梗死(STEMI)预后评估的基本工具。肺部超声(LUS)已成为诊断和预测心力衰竭(HF)和 STEMI 患者预后的重要辅助手段,即使是亚临床充血患者也不例外。我们创建了一种新的分类方法(Killip pLUS),根据 LUS 结果将 Killip I 和 II 患者重新分类为中间类别(Killip I pLUS)。该类别包括≥1 个阳性区(≥3 条 B 线)的 Killip I 患者和 0 个阳性区的 Killip II 患者。我们的目的是通过与 Killip 分级法和之前基于 LUS 的重新分级法(LUCK 分级法)进行比较,对这一新的分级法进行评估:对 373 名 STEMI 患者进行了入院 24 小时内 LUS 检查。分析了入院后一年内的院内死亡率和主要不良心血管事件(MACE),包括死亡率或因心力衰竭(HF)、急性冠状动脉综合征或中风而再次入院。在预测院内死亡率时,这三种分类的总体比较具有统计学意义:Killip pLUS AUC 0.90 (95% CI 0.85-0.95) vs. Killip AUC 0.85 (95% CI 0.73-0.96) vs. LUCK 0.83 (95% CI 0.70-0.95), p=0.024。在预测随访期间的事件方面,不同量表之间的比较也具有显著性:Killip pLUS 0.77 (95% CI 0.71-0.85) vs. Killip 0.72 (95% CI 0.65-0-79) vs. LUCK 0.73 (95% CI 0.66-0.81), p=0.033.结论:与Killip和LUCK量表相比,Killip pLUS量表在保持简便性的同时增强了风险分层能力。
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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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