Predictors of high Killip class after ST segment elevation myocardial infarction in the era of primary reperfusion
Lourdes Vicent1, Jesús Velásquez-Rodríguez1, María Jesús Valero-Masa1
1Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain.
Insights
Predictors of high Killip class in ST-segment elevation myocardial infarction (STEMI) patients were identified. Early identification of high-risk STEMI patients using these variables can improve in-hospital prognosis.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) outcomes have improved, yet high Killip class patients still face poor prognosis.
- Patients with Killip class II or higher require closer monitoring in specialized cardiac care units.
Purpose of the Study:
- To determine independent predictors of Killip class in patients admitted with acute STEMI.
- To identify factors associated with elevated Killip class in STEMI patients.
Main Methods:
- A non-interventional registry study was conducted in a Cardiac Intensive Care Unit.
- 1111 patients admitted for acute STEMI between January 2010 and April 2015 were included.
- Multivariate analysis was performed to identify independent predictors of high Killip class (≥II).
Main Results:
- 20.7% of patients were classified as Killip class II or higher.
- Independent predictors of Killip class ≥II included older age, female sex, diabetes, prior heart failure, chronic kidney disease, anemia, multivessel disease, anterior STEMI location, prolonged symptom onset to treatment time (>2h), and low TIMI flow grade (<3).
- In-hospital mortality significantly increased with higher Killip class.
Conclusions:
- Killip class in STEMI patients can be predicted using variables available at the time of primary percutaneous coronary intervention.
- Predicting Killip class is strongly associated with in-hospital prognosis for STEMI patients.
Background/Introduction:
Outcome after ST segment elevation myocardial infarction (STEMI), has improved but patients with high Killip class still have a poor prognosis, and those ≥II need a closer monitoring in a specialized cardiac care unit.
Purpose:
We aimed to determine the predictors of Killip class in a group of patients admitted for acute STEMI.
Methods:
Non-interventional registry in a Cardiac Intensive Care Unit. Patients were consecutively included from January 2010 to April 2015, and multivariate analysis was performed to determine independent predictors of high Killip Class.
Results:
We included 1111 patients, mean age was 64.0±14.0years and 258 (23.2%) were female. Primary percutaneous coronary intervention was performed in 991 (89.2%), and 120 (10.8%) only received thrombolysis as acute reperfusion therapy. A total of 230 (20.7%) were in class II or higher. The independent predictors of Killip≥II were (odds ratio [95% confidence interval]): older age (2.1 [1.4-3.0]), female sex (1.6 [1.1-2.2]), diabetes (1.4 [1.0-2.1]), prior heart failure (3.2 [1.4-7.2]), chronic kidney disease (2.0 [1.1-3.6]), anaemia (3.0 [2.0-4.5]), multivessel disease (1.6 [1.1-2.2]), anterior location (2.4 [1.8-3.4]), time of evolution>2h (1.6 [1.1-2.4]), and TIMI flow-grade<3 (1.8 [1.2-2.7]). In-hospital mortality increased with Killip class (I 1.5%, II 3.7%, III 16.7%, IV 36.7%).
Conclusion:
In patients with STEMI Killip class can be predicted with variables available when primary percutaneous coronary intervention is performed and is strongly associated with in-hospital prognosis.
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