ESCALA DE KILLIP PDF

The Killip classification is a system used in individuals with an acute myocardial infarction heart attack , taking into account physical examination and the development of heart failure in order to predict and stratify their risk of mortality. Individuals with a low Killip class are less likely to die within the first 30 days after their myocardial infarction than individuals with a high Killip class. The study was a case series with unblinded, unobjective outcomes, not adjusted for confounding factors, nor validated in an independent set of patients. The setting was the coronary care unit of a university hospital in the USA. Patients with a cardiac arrest prior to admission were excluded. The numbers below were accurate in

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Mexico City. Phone: 52 55 Fax: 52 55 E-mail : hectorglezp hotmail. Received on October 6, ; Accepted on June 28, Introduction : Patients with ST elevation acute myocardial infarction STEMI comprise a heterogeneous population with respect to the risk for adverse events. Primary percutaneous coronary intervention PCI has shown to be better, mainly in high-risk patients.

The c-statistics predictive value of the TIMI risk score for mortality was 0. Reperfusion therapy, either pharmacological or mechanical, is indicated in patients with ST elevation acute myocardial infarction STEMI with duration of less than 12 hours. However, it has been observed that the benefit of primary PCI is different in each group of patients and the benefit is greatest in those at high risk.

The risk scores applied to patients who are treated exclusively with primary PCI have reported favorable results. We hypothesized that the TIMI risk score applied to patients with STEMI without cardiogenic shock who undergo primary PCI predicts in hospital mortality and also identifies a group of patients at high risk of developing other adverse events.

The information for the analysis was obtained prospectively from the database of the Coronary Care Unit of the National Institute of Cardiology in Mexico City, covering the period from October to February The information included demographic data, risk factors, angiographic characteristics, procedures, and in hospital course. We excluded those who at admission had cardiogenic shock and analyzed only those who underwent primary PCI. The TIMI risk score was calculated for each patient using the variables obtained at admission according to the published criteria 8 listed in Table 1.

Mortality during hospitalization was calculated according to the risk score. However, since left ventriculography is not routinely performed during primary PCI in our hospital, the ejection fraction of the left ventricle was taken from echocardiography performed at 24 to 48 hours postprocedure.

In each group, we analyzed the frequency of adverse events during hospital care, including mortality, reinfarction, stroke, heart failure, cardiogenic shock, ventricular arrhythmias, and the presence of the no refow phenomenon.

More than one adverse event could be present in one patient. Analysis was performed with the statistical package SPSS The continuous and discrete variables were expressed as mean and standard deviation SD.

Differences were analyzed with Student's t test to compare two variables and continuous or discrete analysis of variance ANOVA when comparing more than two variables. Differences were considered significant at a p value of less than 0. Ninety patients were excluded: 19 with cardiogenic shock at admission and 71 because the procedure was not performed anatomy was not favorable, normal coronary fow, no significant lesions, or the presence of a large-load thrombus.

We analyzed a total of patients whose baseline characteristics are shown in Table 2. The average age of the population was With respect to cardiac function, The distribution of patients according to TIMI score was as follows: 0 points, 25 patients 4. The overall in hospital mortality was 6. The TIMI risk score was highly predictive of in hospital mortality with a c-statistics of 0. All variables included in the TIMI risk score were present with significantly greater frequency in the high-risk group Table 3.

Adverse events that occurred in both groups during hospitalization are shown in Table 4. We observed that mortality was eight-fold higher in the high-risk group than in the low-risk group Other adverse events also occurred more frequently in the high-risk group: heart failure The incidence of reinfarction and stroke was low and there were no significant differences between both groups. There was no difference between the two groups for stent placement A potentially relevant issue in the treatment of patients with STEMI is that this population is highly heterogeneous regarding their risk of adverse events.

Thus, their correct stratification becomes essential to evaluate their prognosis and to take accurate therapeutic decisions. An ideal risk score must be useful, simple and fast to apply to predict prognosis at short and long range.

The TIMI risk score for STEMI is a clinical stratification calculated with data obtained at hospital presentation that can easily classify patients into low and high risk. It was developed using data from patients treated with thrombolytic therapy in a randomized trial and predicts mortality at 30 days. Thune et al. The CADILLAC risk score reportedly has a better predictive value for mortality at 30 days and one year, but differs from other primary angioplasty risk scores because it includes angiographic parameters such as the presence of three-vessel disease and final TIMI fow, as well as the left ventricle ejection fraction determined by ventriculography.

The progress achieved in reducing in hospital mortality in patients with STEMI increases the importance of predicting other postprocedural complications, that may have a strong influence on patient outcomes. In the meta-analysis of Keeley et al. In our results, there was no difference between high and low-risk groups in the incidence of reinfarction and stroke.

Although the high-risk group presented all the risk factors mentioned above, it has been observed that suboptimal reperfusion may be present in a large proportion of patients despite the achievement of TIMI 3 fow. In the meta-analysis by De Luca et al. We are aware of the relationship between the presence of the no-refow phenomenon and other complications such as increased incidence of fatal arrhythmias and heart failure in patients with STEMI.

Most patients developed cardiogenic shock during hospitalization 19 and Lindholm et al. It would be important to identify this group of at-risk patients, as has been done for patients receiving thrombolytic therapy, 21 so that preventive measures could be implemented in an attempt to prevent the development of cardiogenic shock.

The TIMI risk score applied to STEMI patients without cardiogenic shock, undergoing primary PCI, identifies a group of patients at high-risk not only for higher in hospital mortality, but also for other adverse events such as the no-refow phenomenon, heart failure, development of cardiogenic shock, and ventricular arrhythmias. We appreciate the secretarial staff of the Coronary Care Unit, Leticia Casiano and Benita Medrano, for their valuable cooperation in the preparation of this manuscript.

Management of acute myocardial infarction in patients presenting with ST-segment elevation. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than patients.

Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty.

Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention PAMI risk score. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty. Implications for early discharge. TIMI risk score for ST-elevation myocardial infarction, a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy.

Rev Fed Arg Cardiol ; Zapata G. Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention.

Is primary angioplasty for some as good as primary angioplasty for all? Modeling across trials and individual patients. A simple prognostic classification model for postprocedural complications after percutaneous coronary intervention for acute myocardial infarction from the New York State Percutaneous Coronary Intervention Database.

Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. Microvascular obstruction and the no-refow phenomenon after percutaneous coronary intervention. Unsuccessful reperfusion in patients with ST-segment elevation myocardial infarction treated by primary angioplasty.

Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. Percutaneous coronary intervention for acute MI does not prevent in hospital development of cardiogenic shock compared to fibrinolysis.

Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. Servicios Personalizados Revista. Similares en SciELO. Introduction Reperfusion therapy, either pharmacological or mechanical, is indicated in patients with ST elevation acute myocardial infarction STEMI with duration of less than 12 hours.

Methods The information for the analysis was obtained prospectively from the database of the Coronary Care Unit of the National Institute of Cardiology in Mexico City, covering the period from October to February Discussion A potentially relevant issue in the treatment of patients with STEMI is that this population is highly heterogeneous regarding their risk of adverse events. Conclusions The TIMI risk score applied to STEMI patients without cardiogenic shock, undergoing primary PCI, identifies a group of patients at high-risk not only for higher in hospital mortality, but also for other adverse events such as the no-refow phenomenon, heart failure, development of cardiogenic shock, and ventricular arrhythmias.

Acknowledgment We appreciate the secretarial staff of the Coronary Care Unit, Leticia Casiano and Benita Medrano, for their valuable cooperation in the preparation of this manuscript. References 1.

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Killip Class

Enter your email address and we'll send you a link to reset your password. Please fill out required fields. 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. This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis. Thank you for everything you do.

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Killip class

Mexico City. Phone: 52 55 Fax: 52 55 E-mail : hectorglezp hotmail. Received on October 6, ; Accepted on June 28, Introduction : Patients with ST elevation acute myocardial infarction STEMI comprise a heterogeneous population with respect to the risk for adverse events. Primary percutaneous coronary intervention PCI has shown to be better, mainly in high-risk patients.

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