BackgroundThe classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60.ObjectiveTo validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies.MethodsWe evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. Results: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI).ConclusionThe Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients.

Background: The angiographic characteristics associated with saphenous vein graft degeneration and the high-risk profile of these patients increase the probability of adverse outcomes during and after percutaneous coronary intervention. This study set out to analyze the clinical and angiographic profile of patients, procedural characteristics, and hospital outcomes of percutaneous coronary intervention performed in saphenous vein grafts, and to investigate predictors of in-hospital mortality in this group. Methods: A retrospective, observational study based on records kept by Central Nacional de Intervenções Cardiovasculares (CENIC) between 2006 and 2016. A comparative analysis of the adverse outcomes-periprocedural acute myocardial infarction, need for urgent coronary artery bypass grafting, and all-cause mortality-was performed according to different time periods (2006-2008, 2009-2011 and 2012-2016). Results: A total of 2,361 patients were included in the analysis. The prevalence of periprocedural acute myocardial infarction and mortality did not differ between time periods. No patient in this sample required urgent coronary artery bypass grafting. Simple logistic regression analysis revealed the following inhospital mortality predictors: advanced age, ST-segment elevation acute myocardial infarction, Killip class 3/4, long lesions, thrombi-containing lesions, three-vessel disease and periprocedural acute myocardial infarction. According to multiple logistic regression analysis, age (OR 1.07; 95%CI 1.02-1.13; p=0.01), smoking (OR 3.26; 95%CI 1.13-9.39; p=0.03), ST-segment elevation acute myocardial infarction (OR 10.36; 95%CI 3.96-27.07; p<0.01) and periprocedural acute myocardial infarction (OR 86.08; 95%CI 15.81-468.63; p<0.01) were correlated with mortality outcomes. Conclusion: Identification of in-hospital mortality predictors may contribute to improve procedural planning for adverse events prevention in patients undergoing percutaneous coronary intervention of saphenous vein grafts.

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