Jump to navigation Jump to search The Killip classification is a system used in individuals with an acute myocardial infarction heart attack , taking into account physical examination and the development of heart failure in order to predict and stratify their risk of mortality. Individuals with a low Killip class are less likely to die within the first 30 days after their myocardial infarction than individuals with a high Killip class. The setting was the coronary care unit of a university hospital in the USA. Patients with a cardiac arrest prior to admission were excluded. Patients were ranked by Killip class in the following way: Killip class I includes individuals with no clinical signs of heart failure.
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E-mail: rb. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Background The 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 Methods We evaluated patients with documented AMI and admitted to the CCU, from to , with a mean follow-up of 05 years to assess total mortality.
Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. Kimball 1 in involved bedside stratification.
This stratification was based on the physical examination of patients with possible acute myocardial infarction AMI , and it was used to identify those at the highest risk of death and the potential benefits of specialized care in coronary care units CCUs. There were no objective clinical outcomes nor systematic collection of data or adjustments for confounding factors; moreover, there were no validations in an independent series of patients.
Although originally described in the pre-reperfusion era, the use of this classification in ST-segment elevation myocardial infarction STEMI was further studied in the post-reperfusion era 2 , 3. In contrast, the prognostic value of this classification in non-ST-segment elevation myocardial infarction NSTEMI is not well established, primarily because it has not yet been validated in patients who were not selected from randomized clinical trial databases 4 and considering the paucity of data on late follow-up after AMI.
Therefore, this study aimed to validate the Killip-Kimball classification for total mortality in long-term clinical follow-up and compare its prognostic value in patients with NSTEMI and STEMI in the era of post-reperfusion and modern antithrombotic therapy. Method Study Design This study comprised two designs 7 , 8 : 1 analytical cross-sectional study to determine the clinical characteristics including the Killip-Kimball classification based on the first physical examination on admission, history and previous treatments, as well as diagnostic and therapeutic procedures during hospital stay in patients with a confirmed diagnosis of AMI with or without ST-segment elevation and admitted to the CCU of the Dante Pazzanese Institute of Cardiology IDPC ; 2 after hospital admission, patients were recruited and followed prospectively, even for in-hospital clinical events prospective cohort , in a database between and , with systematic data collection via electronic datasheets.
Sampling We used non-probability sampling considering the paucity of studies that have validated the Killip-Kimball classification to estimate the risk of mortality in patients with AMI in the Brazilian population. It is notable that our sample size was considerably greater than that in the study, which included patients with a suspected diagnosis of AMI. The study excluded patients with unstable angina.
The criteria used for AMI diagnosis was based on the recommendations of the guidelines avaliable between and This condition was confirmed by increased levels of myocardial necrosis biomarkers at the time of AMI between and , i. When the ECG showed ST-segment depression, T-wave inversion, or nonspecific findings in serial tracings along with the increased levels of myocardial necrosis biomarkers, AMI diagnosis without persistent ST-segment elevation was confirmed.
In this study, we analyzed demographic variables age, gender, and ethnicity , cardiovascular risk factors and comorbidities, physical examination information for the Killip-Kimball classification, simple hemodynamic parameters heart rate and systolic and diastolic blood pressure , previous treatments and procedures, and angiographic aspects [affected artery, TIMI flow, extent and severity of coronary artery disease CAD in those undergoing coronary angiography]. We defined total mortality as the clinical outcome of interest, with landmark analysis at day 30 and at the end of the follow-up period.
Analysis of the clinical outcome was based on the time to occurrence of death, according to the cumulative Kaplan-Meier survival curves and depending on the Killip class. Univariate Cox regression analysis included all demographic, clinical, and angiographic variables. The backward stepwise procedure enabled the identification of the independent variables for the risk of death, according to AMI type.
Results Patient characteristics The main general characteristics of patients with AMI are described below as well as shown in Table 1 , according to the Killip class. Overall, the median age IQR was 64 As for the ECG, 4.
Table 1 Clinical characteristics according to the Killip—Kimball Patient characteristics.
Classification de Killip Kimball