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Killip Classification for Heart Failure

Calculators  Cardiovascular
Killip Classification is based on predicting the severness of heart failure in patients with acute coronary syndrome and quantifying the 30 day mortality
Classification
No signs of congestion 1
S3 and basal rales on auscultation 2
Acute pulmonary edema 3
Cardiogenic shock 4
Result:

Background

Measured Factor
Acute myocardial infarction
Measured Factor Disease
  • Acute myocardial infarction
Measured Factor Detail
Killip Classification helps in measuring severity of heart failure and 30 day mortality rate associated with percutaneous coronary intervention for acute myocardial infarction. Classification is divided into four classes each representing different mortality rate at 30 days in chronological order.
Speciality
Cardiologist
Body System
Cardiovascular
Measured Factor Low Impact
  • Class I represents 30 day mortality with 2-3%
Measured Factor High Impact
  • Class IV indicates occurence of AMI is 10-20% at 30 day mortality

Result Interpretation

Ranges Ranges
  • Critical High: Class IV
Result High Conditions
  • Acute myocardial infarction
Test Limitations
Use of additional diagnostic tests are required to determine several conditons for left ventricular dysfunction that may result in additional costs and logistical difficulties
References: 3

Studies

Study Validation 1
This demographic based study was designed to evaluate the performance of killip classification in analyzing the physical examination for heart failure in patients with non-ST-elevation acute coronary syndromes. Information from 26,090 patients with non-ST-elevation acute coronary syndromes was analyzed .The main outcome measure of the study was to find correlation between between Killip classification and all-cause mortality at 30 days and 6 months. Patients were categorized based on the killip classe I,II, III or IV. Results showed that patients with higher killip class were more at risk of developing diabetes, prior myocardial infarction, ST depression and with higher mortality at 30 days and 6 months. Five factors-age, Killip classification, heart rate, systolic blood pressure, and ST depression-provided more than 70% of the prognostic information for 30-day and 6-month mortality. This study concludes that Killip classification is a powerful independent predictor of all-cause mortality in patients with non-ST-elevation acute coronary syndromes
References: 4
Study Validation 2
This validation study was focused to validate the killip classification in predicting the long-term mortality risk in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI). 1906 patients with presentation of acute myocardial infarction (AMI) were involved in the study. A comparative analysis was done in NSTEMI versus STEMI utilizing the killip classification model.  Overall survival and mortality was analyzed using cox model and it was similar across both types of patients. This study concluded that in both NSTEMI and STEMI. The Killip and Kimball classification was a effective prognostic tool determining mortality and overall survival rate.
References: 5
Study Validation 3
The aim of this study was to determine the predictive value of Killip classification of acute myocardial infarction (AMI) in patients undergoing percutaneous coronary intervention (PCI). A total 2,654 patients with AMI were enrolled in the study. Patients were categorized according to killip classes from class I-III. Higher killip class was correlated with increased age (p <0.001), history of diabetes (p <0.02), lower systolic blood pressure and increased heart rate at presentation, greater incidence of renal failure (p <0.001), major arrhythmia (p <0.001). This study concluded that killip classification can be a predictor of in-hospital and 6-month mortality in patients with AMI who are undergoing primary PCI.
References: 6
Study Additional 1
The main aim of this study was to determine the association between Killip class on admission and following left ventricular dilatation in patients with acute myocardial infarction. 129 consecutive patients were involved in the study. Evaluation was done by two-dimensional and Doppler echocardiography. Results showed that patients with >1 killip class had significantly higher end-systolic and end-diastolic volume indexes and wall motion score index compared to patients with class 1. Other evaluation parameters seen in patients were history of diabetes and peak creatine kinase level which had no association with killip class. This study concluded that Killip class >1 on admission is associated with both acute and long-term left ventricular dilatation and Killip class 1 is associated with favorable left ventricular functional indices which may improve over time.
References: 3

References

  1. Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967;20(4):457-64.
  2. Degeare VS, Boura JA, Grines LL, O'neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2001;87(9):1035-8.
  3. Nesković AN, Otasević P, Bojić M, Popović AD. Association of Killip class on admission and left ventricular dilatation after myocardial infarction: a closer look into an old clinical classification. Am Heart J. 1999;137(2):361-7.
  4. Khot UN, Jia G, Moliterno DJ, Lincoff AM, Khot MB, Harrington RA, et al. Prognostic importance of physical examination for heart failure in non-ST-elevation acute coronary syndromes: the enduring value of Killip classification. JAMA. 2003;290(16):2174-81.
  5. Mello BH, Oliveira GB, Ramos RF, Lopes BB, Barros CB, Carvalho Ede O et al. Validation of the Killip-Kimball classification and late mortality after acute myocardial infarction. Arq Bras Cardiol. 2014;103(2):107-17.
  6. Degeare VS, Boura JA, Grines LL, O'neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2001;87(9):1035-8.