Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain.
Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense, Madrid, Spain.
Int J Cardiol. 2017 Dec 1;248:46-50. doi: 10.1016/j.ijcard.2017.07.038.
BACKGROUND/INTRODUCTION: Outcome after ST segment elevation myocardial infarction (STEMI), has improved but patients with high Killip class still have a poor prognosis, and those ≥II need a closer monitoring in a specialized cardiac care unit.
We aimed to determine the predictors of Killip class in a group of patients admitted for acute STEMI.
Non-interventional registry in a Cardiac Intensive Care Unit. Patients were consecutively included from January 2010 to April 2015, and multivariate analysis was performed to determine independent predictors of high Killip Class.
We included 1111 patients, mean age was 64.0±14.0years and 258 (23.2%) were female. Primary percutaneous coronary intervention was performed in 991 (89.2%), and 120 (10.8%) only received thrombolysis as acute reperfusion therapy. A total of 230 (20.7%) were in class II or higher. The independent predictors of Killip≥II were (odds ratio [95% confidence interval]): older age (2.1 [1.4-3.0]), female sex (1.6 [1.1-2.2]), diabetes (1.4 [1.0-2.1]), prior heart failure (3.2 [1.4-7.2]), chronic kidney disease (2.0 [1.1-3.6]), anaemia (3.0 [2.0-4.5]), multivessel disease (1.6 [1.1-2.2]), anterior location (2.4 [1.8-3.4]), time of evolution>2h (1.6 [1.1-2.4]), and TIMI flow-grade<3 (1.8 [1.2-2.7]). In-hospital mortality increased with Killip class (I 1.5%, II 3.7%, III 16.7%, IV 36.7%).
In patients with STEMI Killip class can be predicted with variables available when primary percutaneous coronary intervention is performed and is strongly associated with in-hospital prognosis.
背景/引言：ST 段抬高型心肌梗死（STEMI）患者的预后有所改善，但心功能 Killip 分级较高的患者预后仍较差，需要在专门的心内科监护病房进行密切监测。
我们旨在确定一组急性 STEMI 患者心功能 Killip 分级的预测因素。
这是一项在心脏重症监护病房进行的非干预性登记研究。连续纳入 2010 年 1 月至 2015 年 4 月期间入院的患者，采用多变量分析确定心功能 Killip 分级较高的独立预测因素。
共纳入 1111 例患者，平均年龄为 64.0±14.0 岁，258 例（23.2%）为女性。991 例（89.2%）患者接受了经皮冠状动脉介入治疗，120 例（10.8%）仅接受了溶栓治疗作为急性再灌注治疗。共有 230 例（20.7%）患者心功能分级为 II 级或更高。心功能 Killip≥II 级的独立预测因素包括（比值比[95%置信区间]）：年龄较大（2.1[1.4-3.0]）、女性（1.6[1.1-2.2]）、糖尿病（1.4[1.0-2.1]）、既往心衰（3.2[1.4-7.2]）、慢性肾脏病（2.0[1.1-3.6]）、贫血（3.0[2.0-4.5]）、多支血管病变（1.6[1.1-2.2]）、前壁心肌梗死（2.4[1.8-3.4]）、发病时间>2 小时（1.6[1.1-2.4]）和 TIMI 血流分级<3 级（1.8[1.2-2.7]）。随着心功能 Killip 分级的升高，院内死亡率也随之增加（I 级 1.5%，II 级 3.7%，III 级 16.7%，IV 级 36.7%）。
在接受经皮冠状动脉介入治疗时，可根据心功能 Killip 分级的预测变量来预测 STEMI 患者的心功能分级，且与院内预后密切相关。
