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Killip class at presentation and immediate versus staged multivessel PCI in patients with STEMI
Philipp Jakob1,2, Ferdinando Varbella3, Axel Linke4
1Department of Cardiology, University Heart Center, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Scientific Reports
|June 26, 2026
Summary
Patients with ST-elevation myocardial infarction (STEMI) and higher Killip class face increased mortality risk. Immediate multivessel PCI benefits Killip class I patients but not higher Killip class patients, suggesting a differential treatment effect.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Higher Killip class in ST-elevation myocardial infarction (STEMI) patients correlates with increased mortality.
- Multivessel coronary artery disease (MVD) is common in STEMI patients.
- Optimal revascularization strategy for STEMI patients with MVD and higher Killip class remains debated.
Purpose of the Study:
- To evaluate the outcomes of immediate versus staged multivessel percutaneous coronary intervention (PCI) in STEMI patients with MVD, stratified by Killip class.
- To determine if the benefit of immediate multivessel PCI differs between Killip class I and Killip class ≥II patients.
Main Methods:
- Subgroup analysis of the MULTISTARS AMI trial data.
- Patients with STEMI and MVD were stratified by Killip class (I vs. ≥II).
- Comparison of a composite primary endpoint at 1 year between immediate and staged multivessel PCI strategies within each Killip class subgroup.
Main Results:
- The primary endpoint occurred in 11.4% of Killip class I patients and 17.9% of Killip class ≥II patients (HR, 1.57; p=0.11).
- Immediate multivessel PCI significantly reduced the primary endpoint in Killip class I patients (6.8% vs. 15.8%; p<0.01).
- No significant difference in the primary endpoint was observed between immediate and staged PCI in Killip class ≥II patients (20.0% vs. 15.4%; p=0.55).
- A significant treatment-by-subgroup interaction was found (P interaction=0.029), indicating immediate PCI did not benefit Killip class ≥II patients.
Conclusions:
- The benefit of immediate multivessel PCI in STEMI patients with MVD appears attenuated in those with Killip class ≥II compared to Killip class I.
- Immediate multivessel PCI may not be superior to staged PCI in higher-risk patients (Killip class ≥II).
- Further research is warranted to confirm these findings and guide treatment strategies for STEMI patients with MVD and higher Killip class.
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