Validation of the Killip-Kimball Classification and Late Mortality after Acute Myocardial Infarction

Abstract

BackgroundThe classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60.ObjectiveTo validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies.MethodsWe evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. Results: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI).ConclusionThe Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients.

Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

“…The clinical diagnosis of AHF was confirmed by increased levels of NT-proBNP and decreased EF (<45%). Reduced EF indicates the loss of contractility due to acute ischemia or myocardial necrosis [5,15]. In our STEMI patients, reduced EF was associated with Killip class ≥II, especially in the subset of patients who developed AKI.…”

“…The severity of heart failure was quantified using the Killip classification; patients were categorized in Killip class II, III or IV if they had pulmonary congestion, pulmonary edema or cardiogenic shock, respectively [15].…”

Ansiedade e desfechos clínicos em pacientes coronariopatas submetidos ao cateterismo não programado

“…While the aim of the first one is to estimate the severity of patients after AMI and showed a relevant prognostic performance at a five-year follow-up in patients with ACS, the CCI considers the impact of chronic comorbidities on the chance of survival. (14,24,25) For some participants in this study, the Killip classification II may suggest poor clinical prognosis, even though the CCI was low. (26) In the literature, Killip classification is an independent predictor of in-hospital complications in patients with ACS, whose risk is five times greater in those with anxiety.…”

Acute Coronary Syndromes in Chronic Kidney Disease: Clinical and Therapeutic Characteristics

“…The four classes describe the degree of the pulmonary congestion as a response to the LV disfunction. Cardiogenic shock represents the last class and expresses the presence of haemodynamic instability [19].…”