title: Killip classification in patients with acute coronary syndrome: insight from a multicenter registry.
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.
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, and Weill Cornell Medical School, Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Zubaid
authors.forename: Wael
authors.initials: W
authors.lastname: AlMahmeed
authors.forename: Kadhim
authors.initials: K
authors.lastname: Sulaiman
authors.forename: AbdulRahman
authors.initials: A
authors.lastname: AlNabti
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors