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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.

European Journal of Internal Medicine
|August 18, 2023
PubMed
Summary

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.

Keywords:
Acute myocardial infarctionKillip classificationMINOCAMIOCAOutcomes

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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.