| 김균희¹ , 최원석¹ , 박선희¹ , 배명환¹ , 이장훈¹ , 양동헌¹ , 박헌식¹ , 조용근¹ , 채성철¹ , 전재은¹ , 김영조² , 정명호³, 김기식 ⁴ , 허승호5 |
Background: The aims of this study were to determine the interactive effect of Killip class and left ventricular systolic function on 12-month mortality in patients with acute myocardial infarction (AMI) in modern era. Methods: Between November 2005 and January 2008, 8,418 eligible patients (5,942 men; mean age = 62.7 ± 12.5 years-old) were analyzed from the Korean AMI Registry. Patients were stratified into 4 groups based on Killip class (1 versus ≥2) and left ventricular ejection fraction (LVEF; <50% versus ≥50%); group 1 (Killip class 1 and LVEF ≥50%, n=4,003), group 2 (Killip class 1 and LVEF <50%, n=2,200), group 3 (Killip class ≥2 and LVEF ≥50%, n=851), and group 4 (Killip class ≥2 and LVEF <50%, n=1,344). The LVEF were measured by two-D echocardiography. Results: The 12-month mortality was 2.0% in group 1, 7.3% in group 2, 10.6% in group 3, and 22.5% in group 4, respectively. Kaplan-Meier survival showed there was significant difference in 12-month mortality among 4 groups (log-rank p <0.001). Patients in group 2 had significantly higher 12-month mortality compared with patients in group 1 (hazard ratio [HR] 3.912, 95% confidence interval [CI] 2.728 to 5.610, p<0.001), as did patients in group 3 (HR 3.991, 95% CI 2.592 to 6.145, p<0.001) after adjustment for clinical variables and angiographic variables in Cox proportional hazards model. In fully adjusted model including medications during hospitalization and discharge, patients in group 2 had significantly higher 12-month mortality compared with patients in group 1 (HR 4.041, 95% CI 2.788 to 5.858, p<0.001), as did patients in group 3 (HR 3.359, 95% CI 2.125 to 5.310, p<0.001). The patients in group 4 had the highest 12-month mortality compared to patients in group 1 after adjustment for clinical and angiographic variables (HR 8.282, 95% CI 5.821 to 11.784, p<0.001), and after adjustment for clinical, angiographic, and discharge medications (HR 7.748, 95% CI 5.372 to 11.176, p<0.001). Conclusion: Despite technical improvement and new medical treatment in modern era, conventional risk stratification by Killip class and LVEF still provide prognostic implication on 12-month mortality in post-MI patients.
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