Significance of Lung Ultrasound in hospitalized patients with ST-segment elevation myocardial infarction

Background: ST-segment elevation myocardial infarction (STEMI) is frequently complicated by early elevation of left ventricular filling pressures resulting in pulmonary congestion, which strongly influences short-term clinical outcomes. Clinical assessment alone may underestimate early interstitial lung fluid accumulation. Lung ultrasound (LUS) allows bedside detection and quantification of B-lines as a surrogate of pulmonary congestion. Aim: This prospective cohort study aimed to evaluate the prognostic significance of early lung ultrasound–detected B-line burden in hospitalized STEMI patients and to assess its association with in-hospital adverse outcomes. Methods: Fifty consecutive STEMI patients admitted between November 2024 and October 2025 were enrolled. Lung ultrasound was performed within 24 hours of admission using a standardized 8-zone protocol. Total B-line count was recorded. Patients were followed for in-hospital adverse outcomes, including acute heart failure, cardiogenic shock, and mortality. Multivariable regression and receiver operating characteristic (ROC) analyses were performed. Results: Adverse in-hospital events occurred in 22% of patients. Higher B-line counts were significantly associated with adverse outcomes (P < 0.001). ROC analysis demonstrated that a threshold >3 B-lines predicted complications with an area under the curve (AUC) of 0.93 (95% CI: 0.84–0.99), sensitivity 72.7%, and specificity 94.9%. Conclusion: Early lung ultrasound assessment of pulmonary congestion is strongly associated with adverse in-hospital outcomes in STEMI patients. These findings require validation in larger multicenter cohorts before routine clinical implementation.