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- Title
Prognostic Importance of Physical Examination for Heart Failure in Non–ST-Elevation Acute Coronary Syndromes: The Enduring Value of Killip Classification.
- Authors
Khot, Umesh N.; Jia, Gang; Moliterno, David J.; Lincoff, A. Michael; Khot, Monica B.; Harrington, Robert A.; Topol, Eric J.
- Abstract
Context: In acute myocardial infarction, the presence and severity of heart failure at the time of initial presentation have been formally categorized by the Killip classification. Although well studied in ST-elevation myocardial infarction, the prognostic importance of Killip classification in non–ST-elevation acute coronary syndromes is not well established. Objectives: To determine the prognostic importance of physical examination for heart failure analyzed according to Killip classification in non–ST-elevation acute coronary syndromes and to understand its predictive value relative to other variables. Design, Setting, and Patients: From April 2001 to September 2003, We analyzed information from 26 090 patients with non–ST-elevation acute coronary syndromes enrolled in the GUSTO IIb, PURSUIT, PARAGON A, and PARAGON B trials. Demographic information was categorized by Killip class. Killip classes III and IV were combined into 1 category. Multivariate Cox proportional hazard models were developed to determine the prognostic importance of Killip classification in comparison with other variables. Main Outcome Measure: Association between Killip classification and all-cause mortality at 30 days and 6 months. Results: Patients in Killip class II (n = 2513) and III/IV (n = 390) were older than those in Killip class I (n = 23 187), with higher rates of diabetes, prior myocardial infarction, ST depression, and elevated cardiac enzymes (all P<.001). Higher Killip class was associated with higher mortality at 30 days (2.8% in Killip class I vs 8.8% in class II vs 14.4% in class III/IV; P<.001) and 6 months (5.0% vs 14.7% vs 23.0%, respectively; P<.001). Patients with Killip class II, III, or IV constituted 11% of the overall population but accounted for approximately 30% of the deaths at both time points. In multivariate analysis, Killip class III/IV was the most powerful predictor of mortality at 30 days (hazard ratio [HR], 2.35; 95% confidence inte...
- Subjects
MYOCARDIAL infarction diagnosis; PERIODIC health examinations; HEART failure; CARDIAC arrest; HEART beat; MORTALITY; MULTIVARIATE analysis; HEALTH outcome assessment
- Publication
JAMA: Journal of the American Medical Association, 2003, Vol 290, Issue 16, p2174
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.290.16.2174