Factors Associated with In-Hospital Death in Patients with Killip Class 3 Acute Myocardial Infarction

Abstract

The clinical outcomes in acute myocardial infarction (AMI) patients with Killip class 3 are often inconsistent with those in the literature, and the factors associated with poor outcomes have not been sufficiently investigated. The purpose of this study was to identify factors associated with in-hospital death in AMI patients with Killip class 3. We included 205 AMI patients with Killip class 3, and divided them into a survived group (n = 189) and in-hospital death group (n = 16). The primary objective was to identify factors associated with inhospital death using multivariate analysis. Age was significantly younger in the survived group than in the inhospital death group (73.1 ± 11.2 versus 83.2 ± 6.2 years, P < 0.001). Systolic blood pressure (SBP) was significantly higher in the survived group than in the in-hospital death group (150.0 ± 31.2 versus 124.8 ± 25.3 mmHg, P = 0.002). The prevalence of TIMI thrombus grade "2 was significantly greater in the in-hospital death group than in the survived group (56.3 versus 22.2%, P = 0.005). In multivariate logistic regression analysis, in-hospital death was significantly associated with age [odds ratio (OR) 1.168, 95% confidence interval (CI) 1.061-1.287, P = 0.002] and TIMI thrombus grade "2 (versus !1: OR 5.743, 95% CI 1.717-19.214, P = 0.005), and inversely associated with SBP on admission (per 10 mmHg increase: OR 0.764, 95% CI 0.613-0.953, P = 0.017). In conclusion, in-hospital death was associated with age and coronary thrombus burden, and was inversely associated with SBP on admission in patients with Killip class 3. It may be important to recognize these high risk features to improve the clinical outcomes of patients with Killip class 3.

Predictors on outcomes of cardiovascular disease of male patients in Malaysia using Bayesian network analysis

“…A few studies among the Japanese population state that renal disease and Killip class appear to be related, where acute renal diseases are associated with older age and Killip class II and higher. [30][31][32] This trend is similarly observed in Malaysian STEMI male patients in this study. Also, another study suggests that renal disease occurred more frequently with increasing Killip class, which was then associated with increased in-hospital mortality.…”

“…Ethnicity and age are known as root variables as they have no parents. A few studies among the Japanese population state that renal disease and Killip class appear to be related, where acute renal diseases are associated with older age and Killip class II and higher 30–32. This trend is similarly observed in Malaysian STEMI male patients in this study.…”

“…The Markov blanket term was created by Judea Pearl in 1988 where the Markov blanket of a node A is the set consisting of the parents of A, the children of A and all the other nodes sharing a child with A sometimes known as spouses 10. All these nodes shield node A from the rest of the network 30. In this study, the focus is mainly on the patient status feature.…”

“…10 All these nodes shield node A from the rest of the network. 30 In this study, the focus is mainly on the patient status feature. Nevertheless, the BN gave a characterisation of the whole set of variables; for example, in the BN model for male patients, the Markov blanket for Killip class feature is given by MI history (parent), renal disease (parent), age (spouse) and patient status (child); with these four features, Killip class feature is independent of the remaining ones.…”