Parakh Kapil, Thombs Brett D, Bhat Utsav, Fauerbach James A, Bush David E, Ziegelstein Roy C
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA.
Am J Med. 2008 Nov;121(11):1015-8. doi: 10.1016/j.amjmed.2008.06.020.
Killip classification is an independent predictor of early mortality after myocardial infarction, and the presence of left ventricular systolic dysfunction (left ventricular ejection fraction <50%) and high Killip class predicts poor short-term prognosis. The long-term prognostic significance of Killip class and left ventricular systolic dysfunction, however, is unknown.
We studied the impact of Killip class and left ventricular systolic dysfunction on all-cause mortality (assessed in May 2007 using the Social Security Death Index) in myocardial infarction patients admitted from July 1995 to December 1996.
Of 282 patients, 60% (n=168) were Killip class 1, 23% (n=64) were Killip class 2, and 17% (n=50) were Killip class 3 or 4. Patients with higher Killip class were older and more likely to have diabetes, a non-Q-wave myocardial infarction, renal insufficiency, chronic obstructive pulmonary disease, and left ventricular systolic dysfunction. There were 152 deaths at 10 years after myocardial infarction, and patients with Killip class 2, 3, or 4 had higher mortality compared with Killip class 1 in unadjusted analyses. Patients with left ventricular systolic dysfunction and Killip class of 2 or more had significantly higher 10-year mortality (70 deaths or 76.9%) compared with Killip class 1 patients without left ventricular systolic dysfunction (29 deaths or 34.5%, P <.001). This risk persisted after adjusting for demographics, cardiovascular risk factors, and co-morbidities. Much of the risk was explained by deaths in the first 5 years after myocardial infarction.
Killip class is a strong predictor of long-term mortality, and patients with high Killip class and left ventricular systolic dysfunction are at highest risk.
Killip分级是心肌梗死后早期死亡率的独立预测因素，左心室收缩功能障碍（左心室射血分数<50%）及高Killip分级提示短期预后不良。然而，Killip分级和左心室收缩功能障碍的长期预后意义尚不清楚。
我们研究了Killip分级和左心室收缩功能障碍对1995年7月至1996年12月收治的心肌梗死患者全因死亡率（2007年5月使用社会保障死亡指数评估）的影响。
282例患者中，60%（n=168）为Killip 1级，23%（n=64）为Killip 2级，17%（n=50）为Killip 3级或4级。Killip分级较高的患者年龄较大，更易患糖尿病、非Q波心肌梗死、肾功能不全、慢性阻塞性肺疾病及左心室收缩功能障碍。心肌梗死后10年有152例死亡，未校正分析中，Killip 2级、3级或4级患者的死亡率高于Killip 1级患者。与无左心室收缩功能障碍的Killip 1级患者相比，左心室收缩功能障碍且Killip分级为2级或更高的患者10年死亡率显著更高（70例死亡或76.9%）（29例死亡或34.5%，P<.001）。在调整人口统计学、心血管危险因素及合并症后，这种风险仍然存在。大部分风险可由心肌梗死后前5年的死亡解释。
Killip分级是长期死亡率的有力预测因素，Killip分级高且左心室收缩功能障碍的患者风险最高。
