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Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for
V S DeGeare1, J A Boura, L L Grines
1Department of Cardiology, Brooke Army Medical Center/MCHE-MDC, Fort Sam Houston, Texas 78234-6200, USA. Vincent.DeGeare@CEN.AMEDD.ARMY.MIL
Insights
The Killip classification effectively predicts mortality in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Higher Killip classes correlate with increased in-hospital and 6-month mortality, proving its clinical utility.
Area of Science:
- Cardiology
- Clinical Medicine
- Interventional Cardiology
Background:
- The prognostic significance of Killip classification in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI) requires further elucidation.
- Existing data on Killip class utility in the context of primary PCI is limited, necessitating a comprehensive analysis.
Purpose of the Study:
- To evaluate the predictive value of Killip classification at hospital admission for in-hospital and 6-month mortality in patients with AMI undergoing primary PCI.
- To determine if Killip class remains an independent predictor of mortality after adjusting for other clinical variables.
Main Methods:
- A pooled analysis of 2,654 patients with AMI from 3 primary angioplasty trials was conducted.
- Univariate and multivariate logistic regression analyses were used to assess the association between Killip class and mortality outcomes.
- Patients were categorized into Killip class I, II, and III, with class IV excluded.
Main Results:
- Higher Killip classification was significantly associated with increased in-hospital (2.4% for I, 7% for II, 19% for III) and 6-month mortality (4% for I, 10% for II, 28% for III).
- Increased Killip class correlated with adverse clinical factors including older age, diabetes, lower blood pressure, higher heart rate, multi-vessel disease, reduced ejection fraction, and elevated creatine phosphokinase.
- Higher Killip class also predicted greater need for intra-aortic balloon counterpulsation, renal failure, major arrhythmias, and major bleeding.
Conclusions:
- Killip classification at hospital admission is a simple yet powerful independent predictor of both in-hospital and 6-month mortality in AMI patients undergoing primary PCI.
- The findings underscore the continued clinical relevance of the Killip classification for risk stratification in this patient population.
Abstract:
The predictive value of Killip classification of acute myocardial infarction (AMI) in patients undergoing percutaneous coronary intervention (PCI) is not well established. We performed a pooled analysis of 2,654 patients with AMI enrolled in 3 primary angioplasty trials. Of these, 2,305 patients were class I, 302 were class II, and 47 were class III (class IV patients were excluded). Univariate and multivariate analyses were performed to determine if Killip class at admission was a predictor of in-hospital and 6-month mortality. Higher Killip classification was associated with greater in-hospital (2.4%, 7%, and 19% for class I, II, and III, respectively) and 6-month mortality (4%, 10%, and 28% for class I, II, and III, respectively). Higher Killip class was associated with increased age (p <0.001), history of diabetes (p <0.02), lower systolic blood pressure and higher heart rate at presentation (p <0.0001 for both), more 3-vessel disease (p <0.001), lower left ventricular ejection fraction (p <0.0001), and higher peak creatine phosphokinase (p <0.0001). With each increasing Killip class, there was an increased need for an intra-aortic balloon counterpulsation (p <0.001) and greater incidence of renal failure (p <0.001), major arrhythmia (p <0.001), and major bleeding (p <0.001). After controlling for potential confounding variables, Killip classification remained a multivariate predictor of mortality at both time end points. Killip classification at hospital admission remains a simple and useful independent predictor of in-hospital and 6-month mortality in patients with AMI who are undergoing primary PCI.