Predictors of In-hospital Mortality in High Killip Class Acute ST-segment Elevation Myocardial Infarction after Reperfusion
Abstract
Objective: This study aimed to identify the predictors of in-hospital mortality in acute ST-segment Elevation Myocardial Infarction (STEMI) patients presenting with high Killip class following reperfusion.
Material and Methods: A retrospective cohort study was conducted at Surat Thani Hospital from October 1, 2020, to September 30, 2022. Acute STEMI patients who received percutaneous coronary intervention (PCI) were enrolled. The primary outcome was in-hospital mortality.
Results: A total of 234 patients classified as high Killip class (III or IV) were enrolled in this cohort study. The in-hospital mortality rate was 18.8%. Independent predictors associated with in-hospital mortality were hemoglobin level <12 g/dL (OR=5.57; 95% CI=1.92–16.17, p-value=0.002), mean arterial pressure <65 mmHg (OR=5.80; 95% CI=1.93–17.43, p-value=0.002), receiving more than two vasopressors (OR=7.19; 95% CI=2.49–20.77, p-value<0.001), and multivessel PCI (OR=14.65; 95% CI=2.84–75.67, p-value=0.001). Intubation as a supportive intervention prior to reperfusion therapy was associated with decreased in-hospital mortality (OR=0.27; 95% CI=0.10–0.73, p-value<0.010).
Conclusion: STEMI patients with a high Killip class receiving reperfusion therapy exhibited high in-hospital mortality. Predictive factors included low hemoglobin, low mean arterial pressure, multiple vasopressors, and multivessel PCI. Early intubation is associated with improved clinical outcomes.
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WHO. Framework for the care of acute coronary syndrome and stroke 2024 [homepage on the Internet] [cited 2025 Jan 22] Available from: https://www.who.int/publications/i/item/9789240103665.
Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;144:e368-e454.
Heart Association of Thailand under the Royal Patronage of HMtK. Thai guidelines on acute coronary syndrome 2020. Bangkok: Heart Association of Thailand; 2020.
Byrne R, Coughlan JJ, Rossello X, Ibanez B. Key priorities for the implementation of the 2023 ESC Guidelines for the management of acute coronary syndromes in low-resource settings. Eur Heart J Qual Care Clin Outcomes 2025;11:766-72. doi: 10.1093/ehjqcco/qcae107.
Corbett SJ, Ftouh S, Lewis S, Lovibond K. Acute coronary syndromes: summary of updated NICE guidance. BMJ 2021;372:m4760. doi: 10.1136/bmj.m4760.
Wong GC, Welsford M, Ainsworth C, Abuzeid W, Fordyce CB, Greene J, et al. 2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion. Can J Cardiol 2019;35:107-32.
Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720-826.
Killip T, 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967;20:457-64.
Khera S, Kolte D, Palaniswamy C, Mujib M, Aronow WS, Singh T, et al. ST-elevation myocardial infarction in the elderly--temporal trends in incidence, utilization of percutaneous coronary intervention and outcomes in the United States. Int J Cardiol 2013;168:3683-90.
Tao D, Liu C, Wan S. Machine learning algorithms for predicting in-hospital mortality in patients with ST-segment elevation myocardial infarction [homepage on the Internet]. arXiv; 2022. Available from: https://arxiv.org/abs/2211.14480
Krüth P, Zeymer U, Gitt A, Jünger C, Wienbergen H, Niedermeier F, et al. Influence of presentation at the weekend on treatment and outcome in ST-elevation myocardial infarction in hospitals with catheterization laboratories. Clin Res Cardiol 2008;97:742-7.
Tan JWC, Chew DP, Lo ST, Henry TD, Lin W, Chia YW, et al. Asian pacific society of cardiology consensus statements on the diagnosis and management of acute mi-cardiogenic shock and endorsed by the asian pacific society of interventional cardiology. J Asian Pac Soc Cardiol 2024;3:e10. doi: 10.15420/japsc.2023.40.
Kumwichar P, Thungthong J, Liabsuetrakul T, Tachimori H, Hosozawa M, Saito E, et al. Impact of access to coronary angiography and percutaneous coronary intervention on in-hospital and five-year mortality in patients with acute coronary syndrome: a propensity-matched cohort study in Thailand. Glob Health Res Policy 2024;9:48.
Vicent L, Velásquez-Rodríguez J, Valero-Masa MJ, Díez-Delhoyo F, González-Saldívar H, Bruña V, et al. Predictors of high Killip class after ST segment elevation myocardial infarction in the era of primary reperfusion. Int J Cardiol 2017;248:46-50.
Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, et al. Scai shock stage classification expert consensus update: a review and incorporation of validation studies. J Am Coll Cardiol 2022;79:933-46.
Mukaida T, Kataoka Y, Murai K, Sawada K, Iwai T, Matama H, et al. Predictive models of in-hospital deterioration of Society of Cardiovascular Angiography and Intervention shock stage in patients with acute myocardial infarction initially presenting with stable hemodynamic condition. Cardiovasc Diagn Ther 2024;14:1148-60.
Reddy AJ, Lam SW, Bauer SR, Guzman JA. Lactic acidosis: Clinical implications and management strategies. Cleve Clin J Med 2015;82:615-24.
Chrusch C, Bands C, Bose D, Li X, Jacobs H, Duke K, et al. Impaired Hepatic Extraction and Increased Splanchnic Production Contribute to Lactic Acidosis in Canine Sepsis. Am J Respir Crit Care Med 2000;161:517-26.
Wichian C, Morasert T, Tongyoo S, Koson N. Predictor of in-hospital mortality among acute coronary syndrome patients after treatment with an intra-aortic balloon pump in tertiary Hospital, Thailand. Siriraj Med J 2020;72:462-9.
Lipsic E, van der Horst IC, Voors AA, van der Meer P, Nijsten MW, van Gilst WH, et al. Hemoglobin levels and 30-day mortality in patients after myocardial infarction. Int J Cardiol 2005;100:289-92.
Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005;111:2042-9.
Gili S, D’Ascenzo F, Lococo MF, Moretti C, Gaita F, Raposeiras-Roubín S, et al. Impact of blood transfusion on in-hospital myocardial infarctions according to patterns of acute coronary syndrome: Insights from the BleeMACS registry. Int J Cardiol 2016;221:364-70.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-77.
Thiele H, Akin I, Sandri M, Fuernau G, Waha Sd, Meyer-Saraei R, et al. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 2017;377:2419-32. doi: 10.1056/NEJMoa1710261.
Sucato V, Madaudo C, Marotta A, Ortello A, Camarda EA, Comparato F, et al. Optimal timing of angiography-guided complete revascularization of non-culprit lesions in STEMI patients with multivessel disease. J Clin Med 2024;13:5070. doi: 10.3390/jcm13175070.
Chen Y, Li M, Wu Y. The optimal timing for intervention in patients with ST-segment elevation myocardial infarction and multivessel disease: a systematic review and meta-analysis. Front Cardiovasc Med 2024;11:1389017.
van Diepen S, Hochman JS, Stebbins A, Alviar CL, Alexander JH, Lopes RD. Association between delays in mechanical ventilation initiation and mortality in patients with refractory cardiogenic shock. JAMA Cardiol 2020;5:965-7.
Ginanjar E, Yamin M, Wijaya IP, Harimurti K. Predictors of 30-day mortality in ST-elevation myocardial infarction (STEMI) patients. Acta Med Indones 2019;51:238-44.
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