IN-HOSPITAL OUTCOMES OF MECHANICALLY VENTILATED PATIENTS WITH ADVANCED KILLIP CLASS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Authors

  • Mishal Kharl National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Author
  • Khalid Naseeb National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Author
  • Aisha Hussain National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Author
  • Reema Ashok National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Author
  • Muhammad Saeed Khan National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Author
  • Sadam Hussain Medicare Hospital, Pakistan. Author
  • Raheel Gul National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Author

DOI:

https://doi.org/10.71000/71zw6x89

Keywords:

Arrhythmias, Cardiogenic Shock, Critical Care, Intra-Aortic Balloon Pump, Mechanical Ventilation, Myocardial Infarction, Percutaneous Coronary Intervention, Renal Replacement Therapy, ST-Elevation Myocardial Infarction, Ventilators

Abstract

Background: Patients with acute ST-elevation myocardial infarction (STEMI) who present in advanced Killip class and require mechanical ventilation represent a critically ill population with a heightened risk of adverse in-hospital outcomes. Understanding the prognostic impact of interventions in this group is essential for guiding management and improving outcomes.

Objective: To determine in-hospital outcomes among mechanically ventilated patients with Killip class III or IV undergoing primary percutaneous coronary intervention (PPCI).

Methods: This descriptive cross-sectional study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, over a six-month period. A total of 295 patients meeting inclusion criteria—age ≥18 years, STEMI diagnosis, Killip class III/IV, and requiring mechanical ventilation—were enrolled through non-probability consecutive sampling. Demographic, clinical, procedural, and outcome data were collected and analyzed using SPSS version 24. Chi-square and Fisher’s exact tests were applied for stratified outcome comparison, with a significance threshold of p ≤ 0.05.

Results: The mean age of patients was 61.4 ± 11.2 years, with 72.2% males. Invasive ventilation was used in 68.1% of cases. Overall in-hospital mortality was 13.9%, with significantly higher mortality in patients receiving invasive ventilation (17.4% vs. 6.4%, p = 0.011). Arrhythmias occurred in 28.1%, stroke in 12.2%, and RRT was needed in 14.9% of cases. Use of intra-aortic balloon pump (IABP) was significantly associated with increased arrhythmia rates (p = 0.002) and prolonged ICU stays (p < 0.001).

Conclusion: Mechanically ventilated patients with advanced Killip class undergoing PPCI have high rates of in-hospital complications and mortality. Invasive interventions and supportive measures correlate with adverse outcomes, underscoring the need for timely risk stratification and individualized management strategies.

Author Biographies

  • Mishal Kharl, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

    Postgraduate FCPS / Clinical Fellow, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

  • Khalid Naseeb, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

    Assistant or Associate Professor, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

  • Aisha Hussain, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

    Postgraduate FCPS / Clinical Fellow, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

  • Reema Ashok, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

    Postgraduate FCPS / Clinical Fellow, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

  • Muhammad Saeed Khan, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

     Postgraduate FCPS / Clinical Fellow, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

  • Sadam Hussain, Medicare Hospital, Pakistan.

    MBBS, Medicare Hospital, Pakistan.

  • Raheel Gul, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

     Postgraduate FCPS / Clinical Fellow, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

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Published

2025-04-16