Predictors of In-hospital Outcomes after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Patients with a High Killip Class

Abstract

Objective The predictors of in-hospital outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated with heart failure or cardiogenic shock at presentation remain unclear. Methods Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary PCI results, and in-hospital prognoses were retrospectively compared between primary PCI-treated AMI patients with a Killip class status of ! 2 (Killip 2-4 patients, n=390) and those with a Killip class 1 status (Killip 1 patients, n=1,057). Results The Killip 2-4 patients were more likely to have a higher age and proportion of women and exhibited a higher prevalence of previous myocardial infarction, diabetes mellitus and chronic kidney disease or anemia on admission, lower systolic blood pressure (SBP) values on admission, a higher rate of multivessels or left main trunk as the culprit artery, a larger number of diseased vessels, a lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI and a significantly higher in-hospital mortality rate than the Killip 1 patients. According to a multivariate analysis, age was found to be an independent positive predictor of in-hospital mortality, while admission SBP was an independent positive predictor of in-hospital survival in both groups. In contrast, anemia on admission was found to be an independent predictor of in-hospital death, while the TIMI 3 flow in the IRA after PCI was found to be an independent factor for survival in the Killip 2-4 patients, but not the Killip 1 patients. Conclusion Anemia on admission and the final TIMI 3 flow in the IRA are critical determinants of inhospital death in AMI patients with a Killip class status of ! 2 undergoing primary PCI.

Prognostic Factors for In-Hospital and Long-Term Survival in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

“…Additionally, previous evidence indicates that a higher Killip class is associated with more severe heart failures and higher probabilities of postoperative infection. This is especially the case for patients with a Killip class III or higher (Shiraishi et al 2014). The GRACE risk score is a widely used prognostic scale for acute coronary syndrome and it has been shown to be a meaningful prognostic factor for in-hospital mortality in patients with STEMI (Nassar Junior et al 2013).…”

Is the Prognosis Favourable in Patients without Cardiogenic Shock on Admission Following Acute Myocardial Infarction in the Left Main Trunk?

“…It has been shown that patients achieving a final TIMI 3 flow after primary PCI have a better prognosis than those showing coronary slow flow in patients with AMI 17) . Furthermore, achievement of TIMI 3 flow is an independent factor for survival in patients with Killip classification II or more, but not in patients with Killip classification I 18) . On multivariate analysis in our study, the proportion of patients with coronary slow flow was higher in the CS group than in the non-CS group.…”

Relationship of the ORBIT and HAS-BLED scores with Killip class 3-4 in patients with ST-segment elevation myocardial infarction

“…[7–9] At present, most existing studies are limited to reperfusion therapies and the inclusion of heterogeneous populations in terms of the types of acute coronary syndromes. [1,10–12] The Killip classification is a predictor of short- and long-term prognoses for patients with ACS. [13] A previous study showed that the corresponding mortality rates for Killip classes 1, 2, 3, and 4 were 6%, 17%, 38%, and 81%, respectively.…”