Subclinical pulmonary congestion may be associated with worse short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI), even when overt heart failure is absent at presentation. In a retrospective study published in Frontiers in Radiology, the prognostic value of extravascular lung water (EVLW) measured by computed tomography (CT) was evaluated in Killip class 1 STEMI patients who underwent CT before primary percutaneous coronary intervention (PCI). 

The cohort included 249 patients (mean age 59 ± 11 years; 195 men). The primary endpoint was in-hospital major adverse cardiovascular events (MACE), including all-cause mortality, acute heart failure, cardiogenic shock, resuscitated cardiac arrest, or stroke. During hospitalization, 28 patients experienced MACE.

Patients with events had higher Global Registry of Acute Coronary Events (GRACE) scores (144.96 ± 22.95 vs 133.63 ± 19.84; P=0.006) and higher EVLW values (24.24% vs 21.36%; P=0.001). Adding EVLW to the GRACE score increased area under the curve (AUC) from 0.656 to 0.754 (P=0.045), with significant net reclassification improvement (NRI 0.491; P=0.013) and integrated discrimination improvement (IDI 0.060; P=0.019).

These findings suggest CT-derived EVLW may help refine in-hospital risk assessment when combined with established clinical scoring in Killip class 1 STEMI.