Killip Classification for Heart Failure

Killip Classification for Heart Failure could be used in patients with confirmed acute coronary syndrome in both STEMI and NSTEMI for mortality prediction.

Can be used as part of the full clinical picture to help decide among treatment options, including reperfusion therapy and intra-aortic balloon pump placement. Predicts mortality in ACS and is validated for both STEMI and NSTEMI.

Killip Classification for Heart Failure

No signs of congestion
S3 and basal rales on auscultation
Acute Pulmonary oedema
Cardiogenic shock




Class 30-day mortality* In-hospital mortality** (historical interest only)
0 0 0

Killip classification:

Class INo signs of congestion
Class IIS3 and basal rales on auscultation
Class IIIAcute pulmonary oedema
Class IVCardiogenic shock

Interpretation:

Class30-day mortality*In-hospital mortality** (historical interest only)
I2-3%<6%
II5-12%<17%
III10-20%38%
IV10-20%81%

*From Khot 2003, which combined class III/IV owing to relatively smaller number of patients in class IV (0.3% of patients).
**From Killip 1967. Killip classification developed in the 1960s, before reperfusion therapy (thrombolytics, PCI); has been shown across several studies since then to still be predictive of mortality. However, mortality rates have declined significantly since the original study.

About the creator

Thomas Killip III, MD, is a professor of medicine and cardiology at Mount Sinai Beth Israel Hospital in New York City. He has published dozens of studies in cardiology since the 1960s. Dr. Killip is best known for the heart failure classification system that bears his name. To view Dr. Thomas Killip III’s publications, visit PubMed

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References:

  1. Thomas Killip III, John T. Kimball Treatment of myocardial infarction in a coronary care unit. Two year experience with 250 patients. Symposium on coronary care unit. 1967, Vol.20(4):P457-464. DOI: https://doi.org/10.1016/0002-9149(67)90023-9
  2. Khot UN, Jia G, Moliterno DJ, Lincoff AM, Khot MB, Harrington RA, Topol EJ. Prognostic importance of physical examination for heart failure in non-ST-elevation acute coronary syndromes: the enduring value of Killip classification. JAMA. 2003 Oct 22;290(16):2174-81. doi: 10.1001/jama.290.16.2174.  PMID: 14570953. https://pubmed.ncbi.nlm.nih.gov/14570953/
  3. DeGeare VS, Boura JA, Grines LL, O’Neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2001 May 1;87(9):1035-8. doi: 10.1016/s0002-9149(01)01457-6. PMID: 11348598. https://pubmed.ncbi.nlm.nih.gov/11348598/
  4. Nesković AN, Otasević P, Bojić M, Popović AD. Association of Killip class on admission and left ventricular dilatation after myocardial infarction: a closer look into an old clinical classification. Am Heart J. 1999 Feb;137(2):361-7. doi: 10.1053/hj.1999.v137.89744. PMID: 9924172. https://pubmed.ncbi.nlm.nih.gov/9924172/

Interactive OSCE Checklist – Emergency care of a patient with chest pain – Acute Coronary Syndrome with ST-segment elevation and equivalents

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• Opening the consultation

• Availability of a defibrillator

• Presenting complaint

• History of presenting complaint

• Past medical history

• Drug history

• Physical examination

• Intravenous access

• Registration of a 12-channel ECG

• Express test for the determination of cardiac troponin, myoglobin, creatine phosphokinase-MB, if possible

• Making preliminary diagnosis

• Drug therapy (basic)

• Evaluation of the door-balloon time (the choice of further reperfusion strategy aimed as soon as possible to restore the coronary blood flow in the infarct-dependent artery)

• Call the nearest reperfusion center

• P2Y12 receptor inhibitor prescription depending on the chosen strategy of reperfusion therapy

• Carrying out thrombolytic therapy as needed

• Transportation to the nearest reperfusion center

Total: 0 / 62
Additional materials: https://clincasequest.hospital/chest-pain-history-taking/ https://clincasequest.hospital/pericarditis/ https://clincasequest.hospital/stephen-smiths-formula/ https://clincasequest.hospital/wellens-syndrome/ https://clincasequest.hospital/aslangers-pattern/ Register on our website right…
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