Myocardial infarction: Killip class measured severity of heart failure.

Clinical bottom line (level 4)

  1. Killip class measured the severity of heart failure with myocardial infarction.
Killip and Kimball: American Journal of Cardiology 1967; 20: 457-464
Expires March 2003

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: coronary care unit, university hospital, USA

250 patients (aged 28 to 94; mean 64, 72% male) with a myocardial infarction

Excluded if
  • cardiac arrest prior to admission


    • Patients were ranked by Killip class
    • 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)



    Outcomes studied:
  • Killip class I
  • Killip class II
  • Killip class III
  • Killip class IV

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    Killip class I ? 81/250 32%
    (27% to 38%)
    Killip class II ? 96/250 38%
    (32% to 44%)
    Killip class III ? 26/250 10%
    (6.6% to 14%)
    Killip class IV ? 47/250 19%
    (14% to 24%)

    Comments

    1. A fundamental paper in classic cardiology.
    2. Worsening Killip class has been found to be independently associated with increasing mortality in several studies.

    Citation

    1. Killip T, and Kimball JT: Treatment of myocardial infarction in a coronary care unit: a two year experience of 250 patients. American Journal of Cardiology 1967; 20: 457-464
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    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: William Rhoton

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure prevalence
    Outcome each Killip class