Killip classification in patients with acute coronary syndrome: insight from a multicenter registry.

Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, and Weill Cornell Medical School, Doha, Qatar.
The American journal of emergency medicine (Impact Factor: 1.54). 01/2012; 30(1):97-103. DOI: 10.1016/j.ajem.2010.10.011
Source: PubMed

ABSTRACT The purpose of this study was to assess the prognostic value of the Killip classification at the presentation in patients with acute coronary syndrome (ACS). In 2007 and over 5 months, 6704 consecutive patients with ACS were enrolled in the Gulf Registry of Acute Coronary Events. Patients were categorized according to Killip classification at presentation (Classes I, II, III, and IV). Patients' characteristics and in-hospital outcomes were analyzed. High Killip classes were defined in 22% of patients. In comparison to Killip Class I, patients with higher Killip class had greater prevalence of cardiovascular risk factors, presented late, were less likely to have angina, and were less likely to receive antiplatelet, statins, and β-blockers. Classes II, III, and IV were associated with higher adjusted odds of death in ST-elevation myocardial infarction (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.25-3.69; OR 6.1, 95% CI 3.41-10.86; and OR 28, 95% CI 15.24-54.70, respectively) and non-ST-elevation acute coronary syndrome (adjusted OR 2.4, 95% CI 1.24-4.82; OR 3.2,95% 1.49-7.02; and OR 9.8, 95% CI 3.79-25.57, respectively). In conclusion, across ACS, patients with higher Killip class had worse clinical profile and were less likely to be treated with evidence-based therapy. High Killip class was independent predictors of mortality in ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome. Physician in the emergency department should be aware of the importance of clinical examination in the risk stratification in patients presenting with ACS.

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: We sought to (1) determine the bleeding rates after primary percutaneous coronary intervention (PPCI) in our institution, where the default strategy has been trans-radial (TR) access in combination with unfractionated heparin (UFH) plus eptifibatide, and (2) compare these with the outcomes of patients treated with bivalirudin in HORIZONS-AMI. BACKGROUND: HORIZONS-AMI demonstrated that in PPCI undertaken via the trans-femoral route, routine use of bivalirudin was associated with lower bleeding rates and improved mortality compared to routine use of UFH plus glycoprotein IIb/IIIa inhibitor (GPI). METHODS: This was a single-center prospective registry of consecutive patients undergoing PPCI from January 2009 to August 2011 at the Queen Elizabeth Hospital Birmingham, UK. Thirty-day major bleeding was defined as per the HORIZONS-AMI criteria and also according to TIMI and GUSTO scales. RESULTS: Of the 432 consecutive patients, 350 fulfilled entry criteria for HORIZONS-AMI. In contrast with HORIZONS-AMI, these subjects were older (62.5 ± 13.7yr vs. 59.8 ± 11.1yr, P<0.05) with a higher rate of cardiogenic shock (6.3% vs. 0.8%, P<0.0001). Despite this higher risk population, the rate of major bleeding was favorable (3.7% [95% CI: 2.0 to 6.3%] vs. 4.9% [4.0 to 6.1%], P=0.32). Similarly, TIMI major bleeding (2.0% [0.8 to 4.1%] vs. 3.1% [2.3 to 3.4%], P=0.10) and GUSTO severe or life-threatening bleeding (0.6% [0.1 to 2.5%] vs. 0.4% [0.2 to 0.9%], P=0.75) were comparable. CONCLUSIONS: Routine TR access for PPCI using UFH plus GPI is associated with a low 30-day rate of major bleeding equivalent to the bivalirudin arm of HORIZONS-AMI. Default trans-radial access for PPCI permits routine use of a GPI without the penalty of high bleeding rates. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 10/2012; · 2.51 Impact Factor


Available from
May 22, 2014