The Killip Classification for Heart Failure quantifies severity of heart failure in NSTEMI and predicts day mortality. CONCLUSION The Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern. The Killip classification was based on the evalua- tion of patients . 1 Killip T , Kimball J. Treatment of myocardial infarction in a coronary care unit: a two.
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Acute Myocardial Infarction in Elderly Patients. Comparative Analysis of the Predictors of Mortality. The Elderly Versus the Young.
Killip Classification for Heart Failure – MDCalc
To study the in-hospital evolution of patients aged 65 years and older, with acute myocardial infarction, who were treated by direct classifiction angioplasty with no fibrinolytic therapy. We studied patients divided into 2 groups as follows: Multivessel disease was more frequent in GI Group I had a lower index of success The predictors of mortality in GI were as follows: Elderly patients had more severe acute myocardial infarction and more extensive disease, a lower index of success, and greater in-hospital mortality.
Previous infarction, anterior location and male sex were identified as predictors of mortality in the elderly group GI. In the coming decades, as has been occurring in developed countries, Brazil will experience the process of population aging.
The intensity of this process is expected to place Brazil’s population as the classivication th most elderly in absolute numbers within the first 25 years of this millennium. Life expectancy in Brazil increased from 43 years in to 65 years in 1. It has been projected to reach 72 years in Because of the large extension and diversity of the country leading to regional differences, this process will not occur in an even manner, being more marked in the southern and southeastern regions than in the northern and northeastern regions 2.
In the southern region, where the sample of this study was collected, and according to the statistics oflife expectancy is As people age, a trend towards a change in the pattern of morbidity and mortality occurs. At the beginning of the 20th century, the major cause of death in Brazil was infectious disease, which has been replaced currently by cardiovascular causes.
Of all chronic diseases, cardiovascular diseases account for the greatest number of hospitalizations in Brazil 3and oimball appear as the cause of death in almost half of the records in the Brazilian capitals in the southern and southeastern regions 2. Compared with the general population, the elderly have a greater number of diseases, mainly chronic, and a high prevalence of coronary artery diseases 3. Acute myocardial infarction and sudden death are frequent initial manifestations of coronary artery disease in the elderly; therefore, early diagnosis is paramount to prevent these complications, and the peculiarities inherent to each age group must be known 4.
These factors cause the prevalence of the disease diagnosed during life to be less than half of the cases of significantly obstructive atherosclerotic disease found at autopsies 5. Initially reported by Hartzler 6claxsification angioplasty for treating acute myocardial infarction was performed in patients who were or were not using thrombolytic agents prior to the procedure.
Direct coronary angioplasty without the previous use of thrombolytic agents has been routinely performed at our service sinceand technical and pharmacological resources resulting from different studies have been incorporated throughout these years.
Among those resources, we highlight the use of coronary stents that optimize the results, especially the incidence of recurring ischemia and late restenosis 7and the use of antithrombotic agents. We carried out a retrospective study of consecutive procedures of mechanical recanalization followed by direct coronary angioplasty for myocardial reperfusion as a treatment for acute myocardial infarction within the first 24 hours of its presentation, with no pharmacological reperfusion, then defined as primary classjfication.
The study comprised a total of patients undergoing direct coronary angioplasty procedures divided into 2 groups as follows: The diagnosis of acute myocardial infarction was confirmed by clinical, electrocardiographic, and hemodynamic findings.
The patients studied were admitted consecutively. The following characteristics were not considered criteria for exclusion: This group was called nonclassified. All patients received nitrates, sedatives, analgesics, 10, units of intravenous heparin and acetylsalicylic acid.
Once the patient or his guardian provided the formal written consent, diagnostic cardiac catheterization and interventional therapy were performed. Direct coronary angioplasty was performed after mechanical recanalization with a 0. Balloon and coronary stents were used for direct coronary angioplasty.
Antiarrhythmic, classificatiln, and vasodilator drugs, beta-blockers and abciximab, invasive continuous hemodynamic monitoring, transitory pacemaker, and the use of intra-aortic balloon followed specific and kkillip indications. After the procedure, all patients were referred to the coronary care unit for electrocardiographic, blood pressure, and hemodynamic monitoring. Data were stored and analyzed with Epi Info software, version 6. Chi-square values were calculated with the Yates correction, in which “p” values were given for a degree of freedom.
SPSS software, version 8. The Student t test, chi-square test, Fisher exact test, median test, and Kruskal-Wallis test were applied for independent samples, and the binomial distribution for the case of a single sample.
The statistical significance level adopted was 5. Of the total kkillip of procedures, patients procedures were 65 years of age or older GIand patients procedures were less than 65 years GII. Of the GI patients, A progressive increase in the frequency of the female sex in more advanced age classiification was observed, and from 65 years of age on this difference was less significant, with a predominance of females after the age of 80 years fig.
Previous infarction was present in 39 Nineteen GI patients 6. Twenty-five patients were considered nonclassified NC tab. The location of acute myocardial infarction was similar, with no significant differences between the 2 groups: No difference regarding the degree of flow was observed between the groups tab.
Success was obtained in In-hospital reocclusion was 8. The following findings were identified as predictors of in-hospital mortality: The comparison between the groups is shown in figure 2. Mortality was greater in females Patients with single-vessel disease in GI had significantly greater mortality than clawsification with single-vessel disease in GII Patients with multivessel disease in GI had mortality of Analyzing in-hospital reocclusion in regard to mortality in GI and GII groups, we observed that 5 of the 26 procedures occurred in GI In the late follow-up, after hospital discharge, the mortality rate was The Kaplan-Meier actuarial curve showed Some authors have reported that acute myocardial infarction in the elderly deserves special consideration because of high in-hospital morbidity and mortality and the pessimistic prognosis during in-hospital stay These findings suggest that the reperfusion methods should be used in that population with confirmed advantages The in-hospital mortality reported is greater in patients in this age group 0.
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Hartzler et al 20 reported a 2. But because females have acute myocardial infarction 10 years later than males do, this can eventually represent a bias in the cutoff for age between males and females. This study showed that elderly patients with acute myocardial infarction are admitted to the hospital with more severe clinical findings than those of younger patients.
In the elderly, atherosclerotic arterial disease clsssification more extensive with multivessel involvement. Primary direct coronary angioplasty in acute myocardial infarction in the elderly had lower indices of success for reperfusion than those found in the younger patients; nevertheless, the procedure had very positive indices In-hospital mortality correlated with the clinical presentation, ie, with the Killip-Kimbal functional class, being significantly greater in functional classes III and IV in both groups fig.
But when the 2 groups were compared with each other, the differences were not statistically significant, suggesting that the severity of the clinical presentation in acute myocardial infarction could be more important than age at presentation of the acute myocardial infarction. Their results were the first accepted and clearly defined indication published in the international literature of the use of percutaneous mechanical reperfusion in acute myocardial infarction.
These results were also comparable to those reported by Lee et al 26 in a pioneering study, which spawned the acceptance of primary direct coronary angioplasty in patients with Killip-Kimball functional classes III and IV. This has opened a new and promising path for research in cardiology.
Maintaining patency in the artery is fundamental for the survival of these patients. Because females have acute myocardial infarction 10 years later than males do, this may eventually mean a bias in the cutoff for age In a recent study, Munhoz and Oliveira 28 reported an unfavorable impact on in-hospital mortality related to in-hospital reocclusion in acute myocardial infarction in patients treated with primary direct coronary angioplasty.
In the present study, in-hospital reocclusion was not shown to be a predictor of mortality in the groups.
As in-hospital reocclusion is not a frequent phenomenon, a greater number of patients would be required, which would demand an excessively long time for sample collection. Even though that number of patients was sufficient for the analysis of other phenomena, classificatiln would probably be lower than the number required to analyze the phenomenon of reocclusion 5 patients in GI and 3 in GII, mortality of The presence of multivessel lesions with a greater extension of atherosclerotic coronary artery disease and statistical significance This confirmed the previous findings 28 that the extensiveness of the disease, which is a decisive factor in the therapeutical approach to atherosclerotic coronary artery disease and has great prognostic importance kkimball the long run, kkllip not represent an unfavorable impact on the initial approach, the in-hospital phase, of acute myocardial infarction.
This also suggests that classfiication approach of the artery responsible for acute myocardial infarction could represent a more significant impact for the patient in this phase, once again suggesting that revascularization of the artery responsible for acute myocardial infarction is more important than complete revascularization in the acute phase of acute myocardial infarction.
Our results for late evolution of global survival in acute myocardial infarction in the classificatiion st year These findings are in accordance with those in previous publications. Advanced age is a risk factor in the evolution of acute myocardial infarction. When compared with the younger group, these patients have a lower index clazsification success and higher in-hospital mortality.
The presence of previous infarction, the anterior wall as the site of acute myocardial infarction, and the male sex were identified as predictors of death clawsification elderly patients. Our findings both in the in-hospital and late phases suggest that coronary angioplasty may be the therapy of choice and not an exception in elderly patients of both sexes.
Further randomized and controlled studies are required to confirm these findings. Being an observational, retrospective, nonrandomized study with no control group may constitute the major limitation for extrapolating the results of our study to other populations. Rio de Clasisfication ; Arteriopatia coronariana no idoso.
Aging and the heart. A Textbook of Cardiovascular Medicine. Percutaneous Transluminal Coronary Angioplasty.
Aplication for acute myocardial infarction. Am J Cardiol ; J Am Coll Cardiol ; 35 suppl A: Killip T, Kimbal T.