Killip class
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2008-05-30T02:48:29Z
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/* The study */
The '''Killip classification''' is a system used in individuals with an [[acute myocardial infarction]] (heart attack), in order to risk stratify them. Individuals with a low Killip class are less likely to die within the first 30 days after their myocardial infarction than individuals with a high Killip class.<ref>Killip T, Kimball JT. ''[http://www.ncbi.nlm.nih.gov/pubmed/6059183?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Treatment of myocardial infarction in a coronary care unit: a two year experience of 250 patients.]'' Am J Cardiol 1967; 20: 457-464 . [[ISSN]] 0002-9149</ref>
==The study==
The study was a [[case series]] with unblinded, unobjective outcomes, not adjusted for confounding factors, nor validated in an independent set of patients. The setting was the [[coronary care unit]] of a university hospital in the USA.
250 patients were included in the study (aged 28 to 94; mean 64, 72% male) with a myocardial infarction. Patients with a [[cardiac arrest]] prior to admission were excluded.
Patients were ranked by Killip class in the following way:
*'''Killip class I''' includes individuals with no clinical signs of [[congestive heart failure|heart failure]].
*'''Killip class II''' includes individuals with rales or crackles in the [[lung]]s, an S<sub>3</sub> [[Heart sounds#Third heart sound S3|gallop]], and elevated jugular venous pressure.
*'''Killip class III''' describes individuals with frank [[acute pulmonary edema]].
*'''Killip class IV''' describes individuals in [[cardiogenic shock]] or [[hypotension]] (measured as [[systolic blood pressure]] lower than 90 mmHg), and evidence of peripheral [[vasoconstriction]] ([[oliguria]], [[cyanosis]] or sweating).
==Conclusions==
Within a 95% [[confidence interval]] the patient outcome was as follows:
*'''Killip class I''': 81/250 patients; 32% (27 to 38%). Mortality rate was found to be at 6%.
*'''Killip class II''': 96/250 patients; 38% (32 to 44%). Mortality rate was found to be at 17%.
*'''Killip class III''': 26/250 patients; 10% (6.6 to 14%). Mortality rate was found to be at 38%.
*'''Killip class IV''': 47/250 patients; 19% (14 to 24%). Mortality rate was found to be at 81%.
The Killip-Kimball classification has played a fundamental role in classic cardiology, having been used as a stratifying criteria for many other studies. Worsening Killip class has been found to be independently associated with increasing mortality in several studies.
Killip class 1 and no evidence of hypotension or [[bradycardia]], in patients presenting with [[acute coronary syndrome]], should be considered for immediate [[intravenous|IV]] [[betablockade]].
==References==
<references />
[[Category:Cardiology]]
[[es:Clasificación de Killip y Kimball]]
[[pl:Klasyfikacja Killipa-Kimballa]]