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Percutaneous coronary intervention in acute coronary syndrome complicated by states Killip 3 and 4 in 2005


Early percutaneous coronary intervention (PCI) is the most effective treatment for acute coronary syndrome (ACS, ST-elevation myocardial infarction (STEMI), non-STEMI, unstable angina pectoris) complicated by states Killip 3 and 4.


A total of 1,187 patients suffering from high-risk acute coronary syndrome (hrACS) were treated in our center in 2005. States Killip 3 and 4 have developed perioperatively in 186 of these patients. International studies have proven high mortality in these patient groups – especially in state Killip 4. Our aim was to analyze the inhospital mortality of the state Killip 3 and 4 patient group treated in our center in 2005.


Seven hundred and two patients with STEMI and 485 patients with hrACS were admitted to our center in 2005. The mortality of these patients was 4.84% (STEMI) and 3.71% (hrACS), and the main cause of this mortality (37.7%) was the Killip 3/4 state, which was observed in 11.9% of the STEMI patients and in 17.9% of hrACS patients (n = 84 and 87). The mean age of the Killip 3/4 patients was 70 ± 10 years. Angiologically successful PCI was performed in 97.9% of the cases. The ratio of revascularized coronaries was left anterior descending coronary artery (LAD): 66 (35.9%), right coronary artery (RCA): 33 (17.9%), circumflex coronary artery (CX): 28 (15.2%), PCI in left main coronary artery: 28 (12.5%), LAD + CX: 15 (8.15%), RCA + LAD: 7 (3.8%), CX + RCA: 6 (3.26%), venous bypass graft: 2 (1.1%). No PCI was performed in two cases. Adjuvant therapies of intraaortic balloon counterpulsation in 67 (36%), mechanical ventilation in 62 (33.3%), continuous veno-venous hemofiltration in 12 (6.45%), and levosimendan therapy in 86 (46.2%) patients were used. Ten (5.4%) of the patients had advanced adult life support (cardiopulmonary resuscitation) (AALS) before arrival at our center, and AALS was performed in the perioperative period in 16 (8.6%) patients. The early inhospital mortality of hrACS aggravated by state Killip 3/4 was 10.7% (20 patients) – according to subgroup: Killip 3: 0.06%; Killip 4: 30.5%.


The prognosis of state Killip 3/4 and successive multiorgan failure as the high-mortality complication of hrACS can be improved by early successful PCI, and the concomitant pharmacologic and nonpharmacologic supportive therapy.

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Zima, E., Szabo, G., Becker, D. et al. Percutaneous coronary intervention in acute coronary syndrome complicated by states Killip 3 and 4 in 2005. Crit Care 11 (Suppl 2), P230 (2007).

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