Unifying Concepts

Killip-Kimball Classification for Acute Myocardial Infarction

The classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU).

The Killip classification is widely used in patients presenting with acute MI for the purpose of risk stratification, as follows:

  • Killip I: with no clinical signs of heart failure,
  • Killip II: with rales in the lungs, third heart sound (S3), and elevated jugular venous pressure,
  • Killip III: with acute pulmonary edema (APE), and
  • Killip IV: with cardiogenic shock or arterial hypotension (measured as systolic blood pressure < 90 mmHg), and evidence of peripheral vasoconstriction (oliguria, cyanosis, and diaphoresis), with mortality rates of 6%, 17%, 38%, and 81%, respectively.



  1. Mello BH, Oliveira GB, Ramos RF, Lopes BB, Barros CB, Carvalho Ede O, Teixeira FB, Arruda GD, Revelo MS, Piegas LS. Validation of the Killip-Kimball classification and late mortality after acute myocardial infarction. Arq Bras Cardiol. 2014 Aug;103(2):107-17. [Medline]
  2. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, Simoons M, Aylward P, Van de Werf F, Califf RM. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation. 1995 Mar 15;91(6):1659-68. [Medline]


Created Oct 05, 2020.

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