Heart and Vessels

, Volume 32, Issue 12, pp 1439–1447 | Cite as

Impact of Killip classification on acute myocardial infarction: data from the SAIKUMA registry

  • Eiji TaguchiEmail author
  • Yutaka Konami
  • Masayuki Inoue
  • Hiroto Suzuyama
  • Kazuhisa Kodama
  • Masayoshi Yoshida
  • Shinzo Miyamoto
  • Koichi Nakao
  • Tomohiro Sakamoto
Original Article


Therapeutic devices for acute myocardial infarction (AMI) have evolved dramatically in recent years. However, the impact of the Killip classification of AMI outcomes in patients undergoing aggressive percutaneous coronary intervention remains unclear. We performed a 10-year retrospective review of 2062 patients diagnosed with AMI, and divided the data into two 5-year intervals: 2005–2009 (n = 1071), and 2010–2014 (n = 991). No difference was observed in in-hospital mortality rate between the two periods (first period, 11.5% vs second period, 9.7%; P = 0.19). The incidence of stent thrombosis was not significantly different between the two periods, and very few thrombi occurred in patients who received second-generation drug-eluting stents (DES) (0.98%: 5/511). In-hospital mortality due to stent thrombosis was high in the full cohort (15%). During the second period, in-hospital mortality was lower in Killip class 4 patients, although the difference was not significant (59.1 vs 47.5%, P = 0.07). Multivariable logistic regression identified several factors that significantly affected in-hospital mortality, including age [odds ratio (OR) 1.07], left main trunk (OR 2.47), peak CPK value above 5000 IU/L (OR 3.18), and Killip class 4 (OR 15.63). We evaluated trends in in-hospital mortality among patients with AMI over a 10-year period. New DES and the frequent use of mechanical support in patients with hemodynamic compromise tended to improve in-hospital mortality, but the effect was not significant. Notably, Killip class 4 on admission was associated with an estimated 16-fold increased risk of in-hospital death.


SAIKUMA registry In-hospital mortality Killip classification 



We thank Naoko Takahashi who assisted with the detailed analysis of the SAIKUMA AMI registry data.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Killip T, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464CrossRefPubMedGoogle Scholar
  2. 2.
    Becker RC, Burns M, Gore JM, Spencer FA, Ball SP, French W, Lambrew C, Bowlby L, Hilbe J, Rogers WJ (1998) Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice. The National Registry of Myocardial Infarction (NRMI-2) Participants. Am Heart J 135:786–796CrossRefPubMedGoogle Scholar
  3. 3.
    Wu AH, Parsons L, Every NR, Bates ER (2002) Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: a report from the second National Registry of Myocardial Infarction(NRMI-2). J Am Coll Cardiol 40:1389–1394CrossRefPubMedGoogle Scholar
  4. 4.
    Steg PG, Dabbous OH, Feldman LJ, Cohen-Solal A, Aumont MC, Lopez-Sendon J, Budaj A, Goldberg RJ, Klein W, Anderson FA Jr (2004) Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the global registry of acute coronary events (GRACE). Circulation 109:494–499CrossRefPubMedGoogle Scholar
  5. 5.
    De Luca G, Suryapranata H, van’t Hof AW, de Boer MJ, Hoorntje JC, Dambrink JH, Gosselink AT, Ottervanger JP, Zijlstra F (2004) Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge. Circulation 109:2737–2743CrossRefPubMedGoogle Scholar
  6. 6.
    Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, Cox DA, Turco M, Stuckey TD, Na Y, Lansky AJ, Gersh BJ, O’Neill WW, Mehran R, Stone GW (2005) Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CALDILLAC risk score. J Am Coll Cardiol 45:1397–1405CrossRefPubMedGoogle Scholar
  7. 7.
    DeGeare VS, Boura JA, Grines LL, O’Neill WW, Grines CL (2001) Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol 87:1035–1038CrossRefPubMedGoogle Scholar
  8. 8.
    El-Menyar A, Zubaid M, AlMahmeed W, Sulaiman K, AlNabti A, Singh R, Al Suwaidi J (2012) Killip classification in patients with acute coronary syndrome: insight from a multicenter registry. Am J Emerg Med 30:97–103CrossRefPubMedGoogle Scholar
  9. 9.
    Bangalore S, Kumar S, Fusaro M, Amoroso N, Attubato MJ, Feit F, Bhatt DL, Slater J (2012) Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117762 patient-years of follow up from randomized trials. Circulation 125:2873–2891CrossRefPubMedGoogle Scholar
  10. 10.
    Di Lorenzo E, Sauro R, Varricchio A, Capasso M, Lanzillo T, Manganelli F, Carbone G, Lanni F, Pagliuca MR, Stanco G, Rosato G, Suryapranata H, De Luca G (2014) Randomized comparison of everolimus-eluting stents and sirolimus-eluting stents in patients with ST elevation myocardial infarction: RACES-MI trial. JACC Cardiovasc Interv 7:849–856CrossRefPubMedGoogle Scholar
  11. 11.
    Brener SJ, Cristea E, Kirtane AJ, McEntegart MB, Xu K, Mehran R, Stone GW (2013) Intra-procedural stent thrombosis: a new risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention for acute coronary syndromes. JACC Cardiovasc Interv 6:36–43CrossRefPubMedGoogle Scholar
  12. 12.
    Palmerini T, Kirtane AJ, Serruys PW, Smits PC, Kedhi E, Kereiakes D, Sangiorgi D, Bacchi Reggiani L, Kaiser C, Kim HS, De Waha A, Ribichini F, Stone GW (2012) Stent thrombosis with everolimus-eluting stents: meta-analysis of comparative randomized controlled trials. Circ Cardiovasc Interv 5:357–364CrossRefPubMedGoogle Scholar
  13. 13.
    Serruys PW, Silber S, Garg S, van Geuns RJ, Richardt G, Buszman PE, Kelbaek H, van Boven AJ, Hofma SH, Linke A, Klauss V, Wijns W, Macaya C, Garot P, DiMario C, Manoharan G, Kornowski R, Ischinger T, Bartorelli A, Ronden J, Bressers M, Gobbens P, Negoita M, van Leeuwen F, Windecker S (2010) Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N Engl J Med 363:136–146CrossRefPubMedGoogle Scholar
  14. 14.
    Yano H, Horinaka S, Ishikawa M, Ishimitsu T (2016) The efficacy of everolimus-eluting stent implantation in patients with ST-segment elevation myocardial infarction: outcomes of 2-year clinical follow -up. Heart Vessels 31:1609–1615CrossRefPubMedGoogle Scholar
  15. 15.
    Wanezaki M, Watanabe T, Nishiyama S, Hirayama A, Arimoto T, Takahashi H, Shishido T, Miyamoto T, Kawasaki R, Fukao A, Kubota I (2016) Trends in the incidences of acute myocardial infarction in coastal and inland areas in Japan: the Yamagata AMI registry. J Cardiol 68:117–124CrossRefPubMedGoogle Scholar
  16. 16.
    Rumana N, Kita Y, Turin TC, Murakami Y, Sugihara H, Morita Y, Tomioka N, Okayama A, Nakamura Y, Ueshima H (2008) Seasonal Pattern of incidence and case fatality of acute myocardial infarction in a Japanese Population (from the Takashima AMI Registry, 1988 to 2003). Am J Cardiol 102:1307–1311CrossRefPubMedGoogle Scholar
  17. 17.
    Nakatsuma K, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Yamamoto T, Suwa S, Horie M, Kimura T (2016) Inter-facility transfer vs. direct admission of patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention. Circ J 80:1764–1772CrossRefPubMedGoogle Scholar
  18. 18.
    Miyachi H, Takagi A, Miyauchi K, Yamasaki M, Tanaka H, Yoshikawa M, Saji M, Suzuki M, Yamamoto T, Shimizu W, Nagao K, Takayama M (2016) Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort. Heart Vessels 31(11):1740–1751CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Shiomi H, Nakagawa Y, Morimoto T, Furukawa Y, Nakano A, Shirai S, Taniguchi R, Yamaji K, Nagao K, Suyama T, Mitsuoka H, Araki M, Takashima H, Mizoguchi T, Eisawa H, Sugiyama S, Kimura T, CREDO-Kyoto AMI investigators (2012) Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study. BMJ 344:e3257CrossRefPubMedGoogle Scholar
  20. 20.
    Berger A, Stauffer JC, Radovanovic D, Urban P, Bertel O, Erne P (2008) Comparison of in- hospital mortality for acute myocardial infarction in Switzerland with admission during routine duty hours versus admission during out of hours (insight into the AMIS Plus Registry). Am J Cardiol 101:422–427CrossRefPubMedGoogle Scholar
  21. 21.
    Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287–1296CrossRefPubMedGoogle Scholar
  22. 22.
    Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCKII): final 12 month results of a randomised, open-label trial. Lancet 382:1638–1645CrossRefPubMedGoogle Scholar
  23. 23.
    Manoukian SV, Feit F, Mehran R, Voeltz MD, Ebrahimi R, Hamon M, Dangas GD, Lincoff AM, White HD, Moses JW, King SB 3rd, Ohman EM, Stone GW (2007) Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial. J Am Coll Cardiol 49:1362–1368CrossRefPubMedGoogle Scholar
  24. 24.
    Andò G, Porto I, Montalescot G, Bolognese L, Trani C, Oreto G, Harrington RA, Bhatt DL (2016) Radial access in patients with acute coronary syndrome without persistent ST-segment elevation: systematic review, collaborative meta-analysis, and meta-regression. Int J Cardiol 222:1031–1039CrossRefPubMedGoogle Scholar
  25. 25.
    Wayangankar SA, Bangalore S, McCoy LA, Jneid H, Latif F, Karrowni W, Charitakis K, Feldman DN, Dakik HA, Mauri L, Peterson ED, Messenger J, Roe M, Mukherjee D, Klein A (2016) Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: a report from the CathPCI Registry. JACC Cardiovasc Interv 9:341–351CrossRefPubMedGoogle Scholar
  26. 26.
    Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ, Vis MM, Wykrzykowska JJ, Koch KT, Baan J, de Winter RJ, Piek JJ, Lagrand WK, de Mol BA, Tijssen JG, Henriques JP (2017) Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 69:278–287CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK 2017

Authors and Affiliations

  • Eiji Taguchi
    • 1
    Email author
  • Yutaka Konami
    • 1
  • Masayuki Inoue
    • 1
  • Hiroto Suzuyama
    • 1
  • Kazuhisa Kodama
    • 1
  • Masayoshi Yoshida
    • 1
  • Shinzo Miyamoto
    • 1
  • Koichi Nakao
    • 1
  • Tomohiro Sakamoto
    • 1
  1. 1.Division of CardiologySaiseikai Kumamoto Hospital Cardiovascular CenterKumamotoJapan

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