Killip Class Shown as Strongest Predictor of Adverse Events for STEMI Patients Undergoing Primary PCI

August 27, 2015—Findings from a pooled analysis of the COMFORTABLE AMI and EXAMINATION trials that sought to identify predictors of adverse events among patients with ST-elevation myocardial infarction (STEMI) undergoing contemporary primary percutaneous coronary intervention (PCI) were published by Masanori Taniwaki, MD, et al in EuroIntervention (2015;11:391–398)

The investigators concluded that Killip class remains the strongest predictor of all-cause death or any reinfarction among STEMI patients undergoing primary PCI, and that using drug-eluting stents (DES) independently predicts a lower risk of target lesion revascularization (TLR) and definite stent thrombosis compared with use of bare-metal stents.

As summarized in EuroIntervention, the investigators pooled individual data of 2,655 patients from these two primary PCI trials (EXAMINATION, N = 1,504; COMFORTABLE AMI, N = 1,161) with identical endpoint definitions and event adjudication. Predictors of all-cause death or any reinfarction and definite stent thrombosis and TLR outcomes at 1 year were identified by multivariable Cox regression analysis. 

The investigators found that Killip class 3 or 4 was the strongest predictor of all-cause death or any reinfarction, definite stent thrombosis (odds ratio [OR] 7.74; 95% confidence interval [CI], 2.87–20.93), and TLR (OR 2.88; 95% CI, 1.17–7.06). 

Independent predictors of all-cause death or any reinfarction included impaired left ventricular ejection fraction (OR 4.77; 95% CI, 2.1–10.82), final TIMI flow 0–2 (OR 1.93; 95% CI, 1.05–3.54), arterial hypertension (OR 1.69; 95% CI, 1.11–2.59), age (OR 1.68; 95% CI, 1.41–2.01), and peak creatine kinase (OR 1.25; 95% CI, 1.02–1.54). The investigators in EuroIntervention reported allocation to treatment with DES was an independent predictor of a lower risk of definite stent thrombosis (OR 0.35; 95% CI, 0.16-0.74) and any TLR (OR 0.34; 95% CI, 0.210.54).