Predictors of high Killip class after ST segment elevation myocardial infarction in the era of primary reperfusion

Abstract

Background/Introduction: Outcome after ST segment elevation myocardial infarction (STEMI), has improved but patients with high Killip class still have a poor prognosis, and those ≥ II need a closer monitoring in a specialized cardiac care unit. Purpose: We aimed to determine the predictors of Killip class in a group of patients admitted for acute STEMI. Methods: Non-interventional registry in a Cardiac Intensive Care Unit. Patients were consecutively included from January 2010 to April 2015, and multivariate analysis was performed to determine independent predictors of high Killip Class. Results: We included 1111 patients, mean age was 64.0 ± 14.0 years and 258 (23.2%) were female. Primary percutaneous coronary intervention was performed in 991 (89.2%), and 120 (10.8%) only received thrombolysis as acute reperfusion therapy. A total of 230 (20.7%) were in class II or higher. The independent predictors of Killip ≥ II were (odds ratio [95% confidence interval]): older age (2.1 [1.4–3.0]), female sex (1.6 [1.1–2.2]), diabetes (1.4 [1.0–2.1]), prior heart failure (3.2 [1.4–7.2]), chronic kidney disease (2.0 [1.1–3.6]), anaemia (3.0 [2.0–4.5]), multivessel disease (1.6 [1.1–2.2]), anterior location (2.4 [1.8–3.4]), time of evolution > 2 h (1.6 [1.1–2.4]), and TIMI flow-grade < 3 (1.8 [1.2–2.7]). In-hospital mortality increased with Killip class (I 1.5%, II 3.7%, III 16.7%, IV 36.7%). Conclusion: In patients with STEMI Killip class can be predicted with variables available when primary percutaneous coronary intervention is performed and is strongly associated with in-hospital prognosis.