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The '''Killip classification''' is a system used in individuals with an [[acute myocardial infarction]] (heart attack), taking into account physical examination and the development of heart failure in order to predict and stratify their risk of mortality. Individuals with a low Killip class are less likely to die within the first 30 days after their myocardial infarction than individuals with a high Killip class.<ref>{{cite journal |vauthors=Killip T, Kimball JT |title=Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients |journal=Am J Cardiol |volume=20 |issue=4 |pages=457–64 |date=Oct 1967 |pmid=6059183 |doi=10.1016/0002-9149(67)90023-9 }}</ref>

==The study==
The study was a [[case series]] with unblinded, unobjective outcomes, not adjusted for confounding factors, nor validated in an independent set of patients. The setting was the [[coronary care unit]] of a university hospital in the USA.

250 patients were included in the study (aged 28 to 94; mean 64, 72% male) with a myocardial infarction. Patients with a [[cardiac arrest]] prior to admission were excluded.

Patients were ranked by Killip class in the following way:
*'''Killip class I''' includes individuals with no clinical signs of [[congestive heart failure|heart failure]].
*'''Killip class II''' includes individuals with rales or crackles in the [[lung]]s, an S<sub>3</sub>, and elevated jugular venous pressure.
*'''Killip class III''' describes individuals with frank [[acute pulmonary edema]].
*'''Killip class IV''' describes individuals in [[cardiogenic shock]] or [[hypotension]] (measured as [[systolic blood pressure]] lower than 90 mmHg), and evidence of peripheral [[vasoconstriction]] ([[oliguria]], [[cyanosis]] or sweating).

==Conclusions==
The numbers below were accurate in 1967. Nowadays, they have diminished by 30 to 50% in every class.{{clarify|date=March 2018}}{{citation needed|date=March 2018}}

Within a 95% [[confidence interval]] the patient outcome was as follows:
{|
|'''Killip class I''': || 81/250 patients; || 32% (27–38%). || Mortality rate was found to be 6%.(current 30-day mortality 2.8)
|-
|'''Killip class II''': || 96/250 patients; || 38% (32–44%). || Mortality rate was found to be 17%.(current 30-day mortality 8.8)
|-
|'''Killip class III''': || 26/250 patients; || 10% (6.6–14%). || Mortality rate was found to be 38%.(current 30-day mortality 14.4)
|-
|'''Killip class IV''': || 47/250 patients; || 19% (14–24%). || Mortality rate was found to be 81%.

|}http://www.theheart.org/article/234239.do
The Killip-Kimball classification has played a fundamental role in classic cardiology, having been used as a stratifying criterion for many other studies. Worsening Killip class has been found to be independently associated with increasing mortality in several studies.

Killip class 1 and no evidence of hypotension or [[bradycardia]], in patients presenting with [[acute coronary syndrome]], should be considered for immediate [[intravenous|IV]] [[beta blocker|beta blockade]].

==References==
{{reflist}}

[[Category:Cardiology]]

Killip class - Revision history

Prab at 12:56, 18 March 2025

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