Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
Crit Care Med. 2011 Mar;39(3):436-42. doi: 10.1097/CCM.0b013e318206ccc3.
Little is known about the outcomes of patients with Killip class III acute ST-segment elevation myocardial infarction in the reperfusion era. This study investigated the short- and long-term outcomes of these patients who underwent primary percutaneous coronary intervention.
Between January 2002 and November 2009, a total of 1,278 consecutive patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention. Of these patients, 230 (17.0%) with Killip III, 216 (16.9%) with Killip II, and 832 (65.1%) with Killip I upon presentation were prospectively recruited.
Angiographic study showed significantly lower final thrombolysis in myocardial infarction 3 flow in patients with Killip III compared with those with Killip II and I (83.5% vs. 94.9% vs. 95.7%, p<.0001). The incidence of multiple vessel disease was also notably higher in Killip III than in Killip II and I (65.7% vs. 13.9% vs. 53.8%, p<.001). Besides, the incidence of advanced congestive heart failure (defined as greater than or equal to New York Heart Association functional class 3) during hospitalization was remarkably higher in Killip III compared to Killip II and I (71.3% vs. 13.9% vs. 6.6%, p<.001). Furthermore, the 30-day mortality and 1-yr cumulative mortality were notably higher in Killip III than in Killip II and I (20.0% vs. 4.2% vs. 1.7%, p<.001 and 31.7% vs. 7.9% vs. 4%, p<.001, respectively). Multivariate analysis showed that Killip III was independently predictive of 30-day and 1-yr mortality (all p < .04).
Killip III remains strongly and independently predictive of 30-day and 1-yr mortality in ST-segment elevation myocardial infarction patients even undergoing primary percutaneous coronary intervention.
在再灌注时代，关于 Killip 分级为 III 级的急性 ST 段抬高型心肌梗死患者的结局知之甚少。本研究旨在探讨接受直接经皮冠状动脉介入治疗的此类患者的短期和长期结局。
2002 年 1 月至 2009 年 11 月，共有 1278 例急性 ST 段抬高型心肌梗死患者接受了直接经皮冠状动脉介入治疗。其中，230 例（17.0%）在就诊时为 Killip III 级，216 例（16.9%）为 Killip II 级，832 例（65.1%）为 Killip I 级，前瞻性地纳入了本研究。
血管造影研究显示，与 Killip II 级和 I 级相比，Killip III 级患者的最终心肌梗死溶栓治疗 3 级血流明显较低（83.5% vs. 94.9% vs. 95.7%，p<.0001）。Killip III 级患者多支血管疾病的发生率也明显高于 Killip II 级和 I 级（65.7% vs. 13.9% vs. 53.8%，p<.001）。此外，与 Killip II 级和 I 级相比，Killip III 级患者在住院期间发生晚期充血性心力衰竭（定义为大于或等于纽约心脏协会功能分级 3 级）的发生率明显更高（71.3% vs. 13.9% vs. 6.6%，p<.001）。此外，Killip III 级患者的 30 天死亡率和 1 年累积死亡率明显高于 Killip II 级和 I 级（20.0% vs. 4.2% vs. 1.7%，p<.001 和 31.7% vs. 7.9% vs. 4%，p<.001）。多变量分析显示，Killip III 是 30 天和 1 年死亡率的独立预测因素（均 p<.04）。
即使接受直接经皮冠状动脉介入治疗，Killip III 分级仍然强烈且独立地预测 ST 段抬高型心肌梗死患者的 30 天和 1 年死亡率。
