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. |