Author/Editor		Pehnec, Zlatko; Tapajner, Alojz
Title		Pomen Killipove klasifikacije srčnega popuščanja v prognozi bolnikov z akutnim koronarnim sindromom in dvigom veznice ST
Translated title		Prognostic value of the Killip classification in patients with ST-segment elevation acute coronary syndromes
Type		članek
Source		Slov Kardiol
Vol. and No.		Letnik 3, št. 1
Publication year		2007
Volume		str. 4-9
Language		slo
Abstract		Background: In patients with the acute coronary syndrome (ACS) the Killip's classification plays an important role in determining the level of cardiac insufficiency and further prognosis. The purpose of the article is to define the characteristics and the prognostic value of Killip's classification in patients with ACS and ST-segment elevation, hospitalised at the intensive care unit (ICU) during 2002 and 2005 Results: During the 4-year period, 899 patients with ACS and ST-segment elevation were hospitalised with the average age of 62.3 +- 13.3 years, 67.5% mate. There were 373 (41.5%) patients with Q-wave AMI of the anterior wall, 447 (49.8%) with Q-wave AMI of other localizations, 47 (5.2%) with AMI without Q-wave, 31 (3.5%) with unstable AP and 140 (15.6%) patients with previous MI. Time-to-hospital admission is set in 784 patients, 322 (41.1%) arrived in less than three hours, 195 (24.9%) in 4-6 hours, 114 (14.5%) in 7-12 hours and 153 (19,5%) in more than 12 hours. The clinical level of cardial insufficiency was defined according to Killip's classification. 599 (66.6%) patients were in Killip class I, 180 (20,0%) in Killip class II, 46 (5.1%) in Killip class III and 74 (8.2%) in Killip class IV. Primary PCI was performed in 603 (67.1%) patients, trombolysis in 97 (10.8%) patients, delayed PCI in 42 (4.7%) patients and non-reperfusion treatment in 156 (17.4%) patients. The average hospitalisation time at ICU was 2.9 ± 3.8 days and the entire hospitalisation 10.7 11.3 days. Intrahospital death rate of patients with regard to the level of cardiac insufficiency was 1.8% in Killip class I, 8.9% in Killip class 11,10.9% in Killip class III and 68.9% in Killip class IV. The multivariate analysis showed that the age of >65 years and the presence of cardiac insufficiency (Killip > I) are the most important independent risk factors of intrahospital death rate.
Summary		Izhodišča. Pri bolnikih z akutnim koronarnim sindromom (AKS) je Killipova klasifikacija pomembna za opredelitev stopnje srčnega popuščanja in njegove prognoze. Namen prispevka je ugotoviti značilnosti in prognostični pomen Killipove klasifikacije pri bolnikih z AKS in dvigom veznice ST, ki smo jih zdravili na Intenzivnem oddelku med Ietoma2002in2005. Rezultati: V obdobju štirih let smo bolnišnično zdravili 899 bolnikov z AKS in dvigom veznice ST, povprečna starost je bila 62,3 -13,3 let, 67,5 °/ je bilo moških. Q-infarkt sprednje stene je imelo 373 (41,5 °/ ), Q-infarkt drugih lokalizacij 447 (49,8 %), srčni infarkt brez zobca Q47 (5,2 %), nestabilno angino pektoris 31 (3,5 %) ter preboleli srčni infarkt 140 (15,6 %) bolnikov. Čas prihoda od začetka bolečine do prihoda v bolnišnico je bil opredeljen pri 784 bolnikih, od katerih je <3 ure potrebovalo 322 (41,1 %), 4-6 ur 195 (24,9 % ), 7-12 ur 114 (14,5%) in <12 ur 153 (19,5 %) bolnikov. Klinična stopnja srčnega popuščanja je opredeljena po Killipovi klasifikaciji. V razredu Kiflip I je bilo 599 (66,6 %), v razredu Killip II 180 (20,0 %), v razredu Killip III 46 (5,1 %) in v razredu Killip IV 74 (8,2 %) bolnikov. Primarni perkutani poseg so opravili pri 603 (67,1 %) bolnikih, trombolizo pri 97 (10,8 %) bolnikih, odložen perkutani poseg pri 42 (4,7 %) bolnikih, 156 (17,4 %) bolnikov pa so zdravili brez reperfuzije. Povprečno trajanje bolnišnične oskrbe na intenzivnem oddelku je bilo 2,9- 3,8 dni, celotno zdravljenje v bolnišnici je trajalo 10,7 11,3 dni. V bolnišnici je umrlo 1,8 % bolnikovv razredu Killip I, 8,9 % v razredu I(illip II, 10,9 %v razredu Killip III in 68,9 % v razredu Killip IV. Multivariatna analiza je pokazala, da sta najpomembnejša neodvisna napovednika smrti v bolnišnici starost > 65 let in prisotnost srčnega popuščanja (Killip > I).
Descriptors		HEART FAILURE, CONGESTIVE ANGINA, UNSTABLE MYOCARDIAL INFARCTION HYPERTENSION TROPONIN ELECTROCARDIOGRAPHY PROGNOSIS