Prognosis

Rank your patient's severity using the Killip classification

Killip class c	Clinical features
I	no clinical signs of heart failure
II	crackles, S3 gallop and elevated jugular venous pressure
III	frank pulmonary oedema
IV	cardiogenic shock - hypotension (systolic < 90 mmHg)  and evidence of peripheral vasoconstriction (oliguria, cyanosis, sweating)

Why?

Worsening Killip class increases the risk of dying

Patient	Prognostic Factor	Outcome	CER	OR (95% CI)	NNF+ (95% CI)
myocardial infarction b	Killip class IV v. I independent	death at 4 weeks	5.1%	7.86 (5.88 to 10.49)	4 (3 to 5)
myocardial infarction	Killip class III v. I independent	death at 4 weeks	5.1%	4.37 (3.34 to 5.71)	7 (5 to 10)
myocardial infarction a	Killip class II or more independent	death at 18 months	4.0%	6.16 (2.01 to 18.83)	6 (3 to 27)

Cardiogenic shock greatly increases the risk of dying

Patient	Prognostic Factor	Outcome	CER	OR (95% CI)	NNF+ (95% CI)
myocardial infarction a	cardiogenic shock independent	death at uncertain duration	14% (13% to 15%)	11.3 (8.22 to 15.5)	1 (1 to 1)