Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
ORIGINAL ARTICLES
Predictors of In-hospital Outcomes after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Patients with a High Killip Class
Jun Shiraishi, Yoshio Kohno, Takeshi Nakamura, Takashi Yanagiuchi, Sho Hashimoto, Daisuke Ito, Masayoshi Kimura, Akihiro Matsui, Hirokazu Yokoi, Masayasu Arihara, Masayuki Hyogo, Takatomo Shima, Takahisa Sawada, Satoaki Matoba, Hiroyuki Yamada, Akiyoshi Matsumuro, Takeshi Shirayama, Makoto Kitamura, Keizo Furukawa, on Behalf of the AMI-Kyoto Multi-Center Risk Study Group
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Keywords: primary percutaneous coronary intervention, Killip classification, anemia
JOURNAL OPEN ACCESS

2014 Volume 53 Issue 9 Pages 933-939

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Abstract

Objective The predictors of in-hospital outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated with heart failure or cardiogenic shock at presentation remain unclear.
Methods Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary PCI results, and in-hospital prognoses were retrospectively compared between primary PCI-treated AMI patients with a Killip class status of ≥2 (Killip 2-4 patients, n=390) and those with a Killip class 1 status (Killip 1 patients, n=1,057).
Results The Killip 2-4 patients were more likely to have a higher age and proportion of women and exhibited a higher prevalence of previous myocardial infarction, diabetes mellitus and chronic kidney disease or anemia on admission, lower systolic blood pressure (SBP) values on admission, a higher rate of multivessels or left main trunk as the culprit artery, a larger number of diseased vessels, a lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI and a significantly higher in-hospital mortality rate than the Killip 1 patients. According to a multivariate analysis, age was found to be an independent positive predictor of in-hospital mortality, while admission SBP was an independent positive predictor of in-hospital survival in both groups. In contrast, anemia on admission was found to be an independent predictor of in-hospital death, while the TIMI 3 flow in the IRA after PCI was found to be an independent factor for survival in the Killip 2-4 patients, but not the Killip 1 patients.
Conclusion Anemia on admission and the final TIMI 3 flow in the IRA are critical determinants of in-hospital death in AMI patients with a Killip class status of ≥2 undergoing primary PCI.

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© 2014 by The Japanese Society of Internal Medicine
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