Despite increased reliance upon sop...

Despite increased reliance upon sophisticated laboratory studies to assess cardiac risk, evidence increasingly indicates that assessment by physical examination for the vicinity or absence of heart failure provides significant prognostic information regarding mortality risk. In this regard, the usefulness of the Killip classification has been established in the words immediately preceding [i]or[/i] following of sinus tachycardia (ST)-elevation myocardial infarction, however it is less well studied with non--ST-elevation acute coronary syndrome Khot and colleagues sought to determine the prognostic importance of the Killip classification in non--ST-segment acute coronary syndrome as well as its predictive value compared with other variables.

The authors heap uped information on Killip classification or physical examination equivalents from several large clinical trials. Killip class I patients were those without heart failure; class II patients had mild heart failure with rales involving undivided third or less of the posterior lung fields and systolic vital current pressure of 90 mm Hg or higher. Class III patients had pulmonary edema with rales involving more than common third of the lung fields and systolic vital fluid pressure of 90 mm Hg or higher. Class IV patients were those in cardiogenic collision with any rales and systolic vital fluid pressure less than 90 mm Hg nevertheless because there were few of these patients, class III and class IV patients were combined for the intents of this study. The primary expiration points were 30-day and six-month all-cause mortality. Other variables included age, heart rate, systolic vital current pressure, body mass index, and creatine kinase MB fraction, as well as sex ST depression, and multiple medical history variables.

Killip classification was available for 26090 (986 percent) of the pond ed study patients. Higher Killip classification was a powerful predictor of all-cause mortality: Killip class II was associated with an increase of more than threefold in 30-day mortality, and Killip class III or IV was associated with an increase of more than fivefold for the same period. The absolute mortality differences between Killip classes increased with time. Although patients with Killip classes II to IV accounted for solely 11 percent of the application of mind population, they accounted for 30 percent of deaths at 30 days and at six months

The authors bring to an end that Killip classification is a powerful independent predictor of all-cause mortality in patients with non--ST-elevation acute coronary syndrome Five factors--age, Killip classification, heart rate, systolic kin pressure, and ST-segment depression in succession electrocardiography--provide more than 70 percent of the prognostic information for 30-day and six-month mortality in these patients. The authors note that physical examination findings continue to play a prominent character in early stratification of patients with acute coronary syndrome regardless of the availability of sophisticated medical equipment and technical expertise.

CAROLINE WELLBERY, MD

Khot UN et al. Prognostic importance of physical examination for heart failure in non--ST-elevation acute coronary syndrome The enduring value of Killip classification. JAMA October 22/29 2003;290:2174-81

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