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Killip Classification — EECC MCQ

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ModerateCoronary Artery DiseaseKillip ClassificationEECC

A 60-year-old man undergoes primary PCI for anterior STEMI. The operator successfully opens the occluded LAD but the patient develops sustained hypotension and a new systolic murmur 4 hours later. Echocardiography shows hyperdynamic basal segments, akinetic apex, LVEF 30%, and moderate-severe mitral regurgitation from papillary muscle dysfunction. What is the Killip classification of this presentation?

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Correct answer: D — Killip class III (acute pulmonary oedema) if pulmonary oedema is present, or Killip class IV (cardiogenic shock) if SBP <90 mmHg persists despite adequate filling — the Killip classification grades HF severity in acute MI and independently predicts mortality

The Killip classification grades acute HF severity in the context of acute MI: Class I: no clinical HF (no rales, no S3) — mortality ~6%; Class II: mild HF (pulmonary rales in <50% lung fields, S3 gallop, elevated JVP) — mortality ~17%; Class III: overt pulmonary oedema (rales in >50% lung fields) — mortality ~38%; Class IV: cardiogenic shock (SBP <90, signs of end-organ hypoperfusion) — mortality ~80% (historical, lower with modern care). This patient with hypotension and new MR likely meets Class III or IV depending on BP response. The 2023 ESC ACS Guidelines use Killip classification alongside GRACE score for risk stratification. Killip class at presentation is an independent predictor of 30-day and long-term mortality, guiding the intensity of monitoring and intervention (Class III-IV requires ICU, consideration of MCS, and urgent assessment for mechanical complications).

Reference: ESC (2023): ACS Guidelines