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Determinants of serious in-hospital complications in patients with Killip class 1/2 ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention

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Abstract

Killip classification has been used to stratify the risk of patients with acute myocardial infarction (AMI). There were many reports that Killip class 3 or 4 is closely associated with poor clinical outcomes. In other words, Killip class 1 or 2 is associated with favorable clinical outcomes in patients with AMI, especially when patients received primary percutaneous coronary intervention (PCI). However, some patients with Killip class 1/2 suffer from serious in-hospital complications. This study aimed to identify factors associated with serious in-hospital complications of ST-segment elevation myocardial infarction (STEMI) in patients with Killip class 1/2. The primary endpoint was serious in-hospital complications defined as the composite of in-hospital death and mechanical complications. We included 809 patients with STEMI, and divided them into the non-complication group (n = 791) and the complication group (n = 18). In-hospital death was observed in 14 patients (1.7%), and mechanical complications were observed in 4 patients (0.5%). Final TIMI flow ≤ 2 was more frequently observed in the complication group (33.3%) than in the non-complication group (5.4%) (p < 0.001). Multivariate logistic regression analysis revealed that serious in-hospital complication was associated with final TIMI flow grade ≤ 2 (Odds ratio 6.040, 95% confidence interval 2.042–17.870, p = 0.001). In conclusion, serious in-hospital complication of STEMI was associated with insufficient final TIMI flow grade in patients with Killip class 1/2. If final TIMI flow grade is suboptimal after primary PCI, we may recognize the potential risk of serious complications even when patients presented as Killip class 1/2.

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All data are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge all staff in the catheter laboratory, ICU/CCU, and cardiology ward in Saitama Medical Center, Jichi Medical University, for their technical support in this study.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan

    Yoichi Hori, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Takunori Tsukui, Masashi Hatori, Taku Kasahara, Yusuke Watanabe, Kei Yamamoto, Masaru Seguchi & Hideo Fujita

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  1. Yoichi Hori
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  2. Kenichi Sakakura
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  3. Hiroyuki Jinnouchi
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  4. Yousuke Taniguchi
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  5. Takunori Tsukui
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  6. Masashi Hatori
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  7. Taku Kasahara
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  11. Hideo Fujita
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Correspondence to Kenichi Sakakura.

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Conflicts of interest

Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, Japan Lifeline, Kaneka, and NIPRO; he has served as a consultant for Boston Scientific. Prof. Fujita has served as a consultant for Mehergen Group Holdings, Inc. Other authors have no conflicts of interest to declare.

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Hori, Y., Sakakura, K., Jinnouchi, H. et al. Determinants of serious in-hospital complications in patients with Killip class 1/2 ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Heart Vessels (2024). https://doi.org/10.1007/s00380-024-02382-w

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