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Published on: September 22, 2020
Predictive value of Killip classification in MINOCA patients
Matteo Armillotta1, Sara Amicone1, Luca Bergamaschi1
1Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Insights
High Killip class predicts worse outcomes in myocardial infarction with non-obstructive coronary artery (MINOCA) patients. This finding supports using Killip classification for MINOCA risk stratification.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- The Killip classification is a standard tool for assessing acute myocardial infarction (AMI) risk.
- Its prognostic value in myocardial infarction with non-obstructive coronary artery (MINOCA) remains underexplored.
- This study aimed to clarify the role of Killip classification in MINOCA.
Purpose of the Study:
- To evaluate the prognostic significance of a high Killip class (greater than I) in MINOCA patients.
- To compare these findings with patients experiencing myocardial infarction with obstructive coronary arteries (MIOCA).
Main Methods:
- Analyzed data from 2455 AMI patients, including 255 MINOCA cases.
- Compared Killip class distribution between MINOCA and MIOCA cohorts.
- Assessed the impact of high Killip class on short-term (in-hospital death, re-AMI, arrhythmias) and long-term outcomes (all-cause mortality, re-AMI, stroke, heart failure hospitalization, MACE).
Main Results:
- High Killip class (Killip >1) was observed in 9.8% of MINOCA patients versus 14.9% of MIOCA patients.
- In MINOCA, high Killip class correlated with increased in-hospital mortality (p=0.002).
- Long-term, high Killip class in MINOCA predicted a threefold increase in mortality (p=0.001) and a fourfold higher risk of heart failure hospitalization (p=0.003).
- High Killip class independently predicted MACE in MINOCA (HR 2.66, p=0.01), alongside age and kidney function.
Conclusions:
- Killip classification retains prognostic value for both short- and long-term outcomes in MINOCA patients.
- This highlights the need for baseline risk stratification in MINOCA, for which Killip class is a valuable tool.
Background:
Killip classification is a practical clinical tool for risk stratification in patients with acute myocardial infarction (AMI). However, its prognostic role in myocardial infarction with non-obstructive coronary artery (MINOCA) is still poorly explored. Our purpose was to evaluate the prognostic role of high Killip class in the specific setting of MINOCA and compare the results with a cohort of patients with obstructive coronary arteries myocardial infarction (MIOCA).
Methods:
This study included 2455 AMI patients of whom 255 were MINOCA. We compared the Killip classes of MINOCA with those of MIOCA and evaluated the prognostic impact of a high Killip class, defined if greater than I, on both populations' outcome. Short-term outcomes included in-hospital death, re-AMI and arrhythmias. Long-term outcomes were all-cause mortality, re-AMI, stroke, heart failure (HF) hospitalization and the composite endpoint of MACE.
Results:
Killip class >1 occurred in 25 (9.8%) MINOCA patients compared to 327 (14.9%) MIOCA cases. In MINOCA subjects, a high Killip class was associated with a greater in-hospital mortality (p = 0.002) and, at long term follow-up, with a three-fold increased mortality (p = 0.001) and a four-fold risk of HF hospitalization (p = 0.003). Among MINOCA, a high Killip class was identified as a strong independent predictor of MACE occurrence [HR 2.66, 95% CI (1.25-5.64), p = 0.01] together with older age and worse kidney function while in MIOCA population also left ventricular ejection fraction and troponin value predicted MACE.
Conclusions:
Killip classification confirmed its prognostic impact on short- and long-term outcomes also in a selected MINOCA population, which still craves for a baseline risk stratification.
