Prognostic Importance of Physical Examination for Heart Failure in Non–ST-Elevation Acute Coronary Syndromes

Khot, Umesh N.; Jia, Gang; Moliterno, David J.; Lincoff, A. Michael; Khot, Monica B.; Harrington, Robert A.; Topol, Eric J.

doi:10.1001/jama.290.16.2174

Cited by 203 publications

(57 citation statements)

References 36 publications

(35 reference statements)

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“…We have previously demonstrated that despite the overall decline in mortality in the reperfusion era, the relatively simple Killip classification was still a useful method for early risk stratification of acute MI [7]. Other studies extended our findings to patients treated by primary percutaneous coronary intervention (PCI) [8], and for patients with non-ST elevation MI as well [9]. …”

Section: Introductionmentioning

confidence: 62%

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Combination of the Killip and TIMI Classifications for Early Risk Stratification of Patients with Acute ST Elevation Myocardial Infarction

Rott

Leibowitz²,

Schwartz³

et al. 2010

Cardiology

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Objective: The Killip classification and the Thrombolysis in Myocardial Infarction (TIMI) score have been proven to be useful tools for the early risk stratification of patients with acute myocardial infarction (MI). The Killip classification is simpler and less time consuming compared to the TIMI score. We sought to evaluate the added value of applying the TIMI score to patients prestratified with the Killip classification. Methods: A total of 1,773 consecutive acute MI patients were hospitalized in 25 coronary care units operating in Israel, and were followed up to 1 year. Results: Higher Killip class was associated with increased 1-year mortality: 6, 24, 42 and 60% in Killip 1–4, respectively. Applying the TIMI score to Killip 1 patients resulted in further stratifying the patients to low-, medium- and high-risk patient groups with 1, 8 and 19% 1-year mortality rates. Conclusions: The Killip classification is a useful tool for early risk stratification of acute MI patients. Applying the TIMI score to patients classified as Killip 1 further stratified them into low-, medium- and high-risk subgroups significantly improving stratification by the Killip classification alone.

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Section: Introductionmentioning

confidence: 62%

“…It enables the physician to stratify a patient on admission, without the need for any sophisticated modalities. Although simple, it is an extremely powerful and well-established method [7,8,9,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Combination of the Killip and TIMI Classifications for Early Risk Stratification of Patients with Acute ST Elevation Myocardial Infarction

Rott

Leibowitz²,

Schwartz³

et al. 2010

Cardiology

View full text Add to dashboard Cite

show abstract

“…Killip class was determined according to clinical manifestations as mentioned before [6]. The components of the GRACE score were age, heart rate, systolic blood pressure, Killip class, cardiac arrest, serum creatinine, ST-segment deviation and cardiac biomarker status [3].…”

Section: Methodsmentioning

confidence: 99%

“…Clinical variables have long been the foundation of risk stratification in ACS [2,3,4,5,6]. More recently, carriers of the *2 loss-of-function allele of CYP2C19, an important CYP450 isoenzyme in the activation process of clopidogrel, have also been showed to be at risk of cardiovascular events [7,8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

The Value of Combining CYP2C19*2 Polymorphism with Classic Risk Factors in Prediction of Clinical Prognosis in Acute Coronary Syndrome Patients

Yan¹,

Chen²,

Qiao³

et al. 2011

Cardiology

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Objectives: To assess the impact of different CYP2C19*2 polymorphisms on clinical outcomes and the effects of CYP2C19*2 polymorphism on predicting clinical outcomes in association with classic risk factors in patients with acute coronary syndromes (ACS). Methods: Between July 2008 and September 2009, 497 consecutive patients with ACS who were admitted to the West China Hospital of Sichuan University were enrolled and underwent CYP2C19*2 determination. The clinical outcomes were the composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. Results: Baseline characteristics were balanced between noncarrier, heterozygous and homozygous groups of the CYP2C19*2 variant. The clinical endpoint occurred more frequently in the homozygous group (HR 4.86, CI 1.62–14.56, p = 0.005). After multivariable analysis, the CYP2C19*2 genetic variant was an independent predictor of cardiovascular events (HR 5.96, CI 1.77–20.03, p = 0.0039) as well as GRACE score and Killip class. The combination of CYP2C19*2 with GRACE score and Killip class increases the potential to predict adverse outcomes. Conclusions: Homozygosity (A/A) for CYP2C19*2 mutant is an independent determinant of prognosis in patients with ACS. The combination of CYP2C19*2 polymorphism with classic risk factors may be a useful tool to predict the risk of cardiovascular events.

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“…Despite overall improvement in mortality rate in each class, compared with data observed during the original development of the classification scheme, the classification scheme remains useful today, as evidenced by data from large myocardial infarction (MI) trials involving STEMI patients (7). The Killip classification is a powerful independent predictor of all-cause mortality in patients with non-ST-elevation acute coronary syndromes (8).…”

mentioning

confidence: 99%

Prognostic value of serum uric acid level in patients with acute myocardial infarction

Chowdary¹,

Kamana²,

Ks³

et al. 2016

Curr Res Cardiol

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OBJECTIVES: To study the relationship between serum uric acid level and Killip classification in pateints with acute myocardial infarction (MI), and the use of serum uric acid levels as a marker of short-term mortality. METHODS: The present study involved 50 patients with acute MI and 50 controls. Serum uric acid level was measured on days 0, 3 and 7 of MI, and compared with all clinical parameters and mortality in the enrolled subjects. RESulTS: There was a statistically significant higher serum uric acid concentration in patients with MI on the day of admission compared with controls. Patients with history of MI had higher serum uric acid levels. On all days, serum uric acid levels were higher in patients who were in a higher Killip class. Two patients who died after three days of hospital stay had a serum uric acid level >7.0 gm/dL and both were in Killip class IV. CONCluSIONS: Serum uric acid levels were higher in patients with acute MI compared with normal healthy individuals. In acute MI, patients with hyperuricemia had higher mortality. Serum uric acid levels correlated with Killip classification in patients with acute MI. Serum uric acid level can be used as a marker of short-term mortality in acute MI, and hyperuricemia may be an indicator of poor prognosis. Serum uric acid levels were elevated in acute MI patients with systemic hypertension and diabetes mellitus.

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Prognostic Importance of Physical Examination for Heart Failure in Non–ST-Elevation Acute Coronary Syndromes

Cited by 203 publications

References 36 publications

Combination of the Killip and TIMI Classifications for Early Risk Stratification of Patients with Acute ST Elevation Myocardial Infarction

Combination of the Killip and TIMI Classifications for Early Risk Stratification of Patients with Acute ST Elevation Myocardial Infarction

The Value of Combining CYP2C19*2 Polymorphism with Classic Risk Factors in Prediction of Clinical Prognosis in Acute Coronary Syndrome Patients

Prognostic value of serum uric acid level in patients with acute myocardial infarction

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