Killip class

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The Killip classification is a system used in individuals with an acute myocardial infarction (heart attack), taking physical examination and the development of heart failure to predict and stratify their risk. 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.[1]

The study[edit]

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.

250 patients were included in the study (aged 28 to 94; mean 64, 72% male) with a myocardial infarction. Patients with a cardiac arrest prior to admission were excluded.

Patients were ranked by Killip class in the following way:


The numbers below were accurate in 1967. Nowadays, they have diminished by 30 to 50% in every class.

Within a 95% confidence interval the patient outcome was as follows:

Killip class I: 81/250 patients; 32% (27–38%). Mortality rate was found to be 6%.(current 30-day mortality 2.8)
Killip class II: 96/250 patients; 38% (32–44%). Mortality rate was found to be 17%.(current 30-day mortality 8.8)
Killip class III: 26/250 patients; 10% (6.6–14%). Mortality rate was found to be 38%.(current 30-day mortality 14.4)
Killip class IV: 47/250 patients; 19% (14–24%). Mortality rate was found to be 81%.

The Killip-Kimball classification has played a fundamental role in classic cardiology, having been used as a stratifying criterion for many other studies. Worsening Killip class has been found to be independently associated with increasing mortality in several studies.

Killip class 1 and no evidence of hypotension or bradycardia, in patients presenting with acute coronary syndrome, should be considered for immediate IV beta blockade.


  1. ^ Killip T, Kimball JT (Oct 1967). "Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients". Am J Cardiol. 20 (4): 457–64. doi:10.1016/0002-9149(67)90023-9. PMID 6059183.