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Validation of the Killip-Kimball classification and late mortality after acute myocardial infarction.

Mello BH, Oliveira GB, Ramos RF, Lopes BB, Barros CB, Carvalho Ede O, Teixeira FB, Arruda GD, Revelo MS, Piegas LS - Arq. Bras. Cardiol. (2014)

Bottom Line: 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 60.We 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.Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI.

View Article: PubMed Central - PubMed

Affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.

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 60.

Objective: To 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.

Methods: We 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).

Conclusion: The 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.

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Related in: MedlinePlus

Mortality (%) according to Killip class and AMI type (at 30-day and long-termfollow-up). **p<0.0001, *p<0.001; NSTEMI: With non-ST-segment elevationMI; STEMI: With ST-segment elevation MI.
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f01: Mortality (%) according to Killip class and AMI type (at 30-day and long-termfollow-up). **p<0.0001, *p<0.001; NSTEMI: With non-ST-segment elevationMI; STEMI: With ST-segment elevation MI.

Mentions: The maximum follow-up time was 6699 days; the average follow-up time was five years,achieved in 99.6% patients. The primary outcome of total mortality was observed in378 patients (i.e., 19.8% of 1906). The frequencies of death, according to the Killipclass, in total long-term clinical follow-up were as follows: Killip class I, 17.7%;II, 27.3%; III, 30.4%; and IV, 48.8% (p < 0.0001). In the analysis according toAMI type, we observed a similar pattern between the NSTEMI and STEMI groups. The samewas observed in the period up to 30 days (Figure1).


Validation of the Killip-Kimball classification and late mortality after acute myocardial infarction.

Mello BH, Oliveira GB, Ramos RF, Lopes BB, Barros CB, Carvalho Ede O, Teixeira FB, Arruda GD, Revelo MS, Piegas LS - Arq. Bras. Cardiol. (2014)

Mortality (%) according to Killip class and AMI type (at 30-day and long-termfollow-up). **p<0.0001, *p<0.001; NSTEMI: With non-ST-segment elevationMI; STEMI: With ST-segment elevation MI.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150661&req=5

f01: Mortality (%) according to Killip class and AMI type (at 30-day and long-termfollow-up). **p<0.0001, *p<0.001; NSTEMI: With non-ST-segment elevationMI; STEMI: With ST-segment elevation MI.
Mentions: The maximum follow-up time was 6699 days; the average follow-up time was five years,achieved in 99.6% patients. The primary outcome of total mortality was observed in378 patients (i.e., 19.8% of 1906). The frequencies of death, according to the Killipclass, in total long-term clinical follow-up were as follows: Killip class I, 17.7%;II, 27.3%; III, 30.4%; and IV, 48.8% (p < 0.0001). In the analysis according toAMI type, we observed a similar pattern between the NSTEMI and STEMI groups. The samewas observed in the period up to 30 days (Figure1).

Bottom Line: 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 60.We 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.Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI.

View Article: PubMed Central - PubMed

Affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.

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 60.

Objective: To 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.

Methods: We 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).

Conclusion: The 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.

Show MeSH
Related in: MedlinePlus