Improved survival after acute myocardial infarction in patients with advanced Killip class
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Updated: Oct 10, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
W L Miller1, R S Wright, J P Grill
1Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Insights
The Killip classification effectively predicts outcomes in acute myocardial infarction (MI) patients, even with modern reperfusion therapies. Advanced Killip classes correlate with higher mortality and complications, highlighting the need for optimized medical therapy alongside interventions.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Prognostics
Background:
- The Killip classification system's utility in stratifying acute myocardial infarction (MI) outcomes requires reevaluation with current reperfusion treatments.
- Assessing the Killip classification's role in predicting short-term and long-term prognosis is crucial for treatment strategy.
- Modern primary reperfusion therapies necessitate a contemporary analysis of the Killip classification's applicability.
Purpose of the Study:
- To test if the Killip classification, assessed upon admission for acute MI, accurately predicts in-hospital mortality and long-term survival.
- To evaluate the Killip classification as an early prognostic tool in acute myocardial infarction (MI) patients.
- To determine the predictive value of the Killip classification in the era of primary reperfusion therapy.
Main Methods:
- Analysis of 909 consecutive Olmsted County patients admitted with acute MI between 1988 and 1998.
- Killip classification assessed on admission served as the primary variable.
- Endpoints included in-hospital death, major in-hospital complications, and post-hospital death.
Main Results:
- In-hospital mortality significantly increased with advanced Killip class (7% Class I, 17.6% Classes II/III, 36% Class IV).
- Higher Killip classes showed a significant correlation with increased in-hospital mortality and complications (p < 0.01).
- Killip classification strongly influenced 24-hour treatment strategies, with Class IV patients more likely to receive primary angioplasty.
Conclusions:
- The Killip classification remains a robust independent predictor of in-hospital mortality, complications, and long-term survival.
- While primary angioplasty has improved outcomes for Killip IV patients, adjunctive medical therapy is underutilized.
- The Killip classification continues to be a valuable tool for risk stratification in acute myocardial infarction (MI).
Background:
The continuing applicability of the Killip classification system to the effective stratification of long-term and short-term outcome in patients with acute myocardial infarction (MI) and its influence on treatment strategy calls for reanalysis in the setting of today's primary reperfusion treatments.
Hypothesis:
Our study sought to test the hypothesis that Killip classification, established on admission in patients with acute MI, is an effective tool for early prediction of in-hospital mortality and long-term survival.
Methods:
A series of 909 consecutive Olmsted County patients admitted with acute MI to St. Marys Hospital, Mayo Clinic, between January 1988 and March 1998 was analyzed. Killip classification was the primary variable. Endpoints were in-hospital death, major in-hospital complications, and post-hospital death.
Results:
Patients analyzed included 714 classified as Killip I, 170 classified as Killip II/III, and 25 classified as Killip IV. Increases in in-hospital mortality and prevalence of in-hospital complications correspond significantly with advanced Killip class (p < 0.01), with in-hospital mortality 7% in class I, 17.6% in classes II/III, and 36% in class IV patients (p < 0.001). Killip classification was strongly associated with mode of therapy administered within 24 h of admission (p < 0.01). Killip IV patients underwent primary angioplasty most commonly and were less likely to receive medical therapy.
Conclusions:
Killip classification remains a strong independent predictor of in-hospital mortality and complications, and of long-term survival. Early primary angioplasty has contributed to a decrease in mortality in Killip IV patients, but effective adjunctive medical therapy is underutilized.
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