The clinical outcomes in acute myocardial infarction (AMI) patients with Killip class 3 are often inconsistent with those in the literature, and the factors associated with poor outcomes have not been sufficiently investigated. The purpose of this study was to identify factors associated with in-hospital death in AMI patients with Killip class 3. We included 205 AMI patients with Killip class 3, and divided them into a survived group (n = 189) and in-hospital death group (n = 16). The primary objective was to identify factors associated with in-hospital death using multivariate analysis. Age was significantly younger in the survived group than in the in-hospital death group (73.1 ± 11.2 versus 83.2 ± 6.2 years, P < 0.001). Systolic blood pressure (SBP) was significantly higher in the survived group than in the in-hospital death group (150.0 ± 31.2 versus 124.8 ± 25.3 mmHg, P = 0.002). The prevalence of TIMI thrombus grade ≥ 2 was significantly greater in the in-hospital death group than in the survived group (56.3 versus 22.2%, P = 0.005). In multivariate logistic regression analysis, in-hospital death was significantly associated with age [odds ratio (OR) 1.168, 95% confidence interval (CI) 1.061-1.287, P = 0.002] and TIMI thrombus grade ≥ 2 (versus ≤ 1: OR 5.743, 95% CI 1.717-19.214, P = 0.005), and inversely associated with SBP on admission (per 10 mmHg increase: OR 0.764, 95% CI 0.613-0.953, P = 0.017). In conclusion, in-hospital death was associated with age and coronary thrombus burden, and was inversely associated with SBP on admission in patients with Killip class 3. It may be important to recognize these high risk features to improve the clinical outcomes of patients with Killip class 3.

Killip 3 级急性心肌梗死 (AMI) 患者的临床结果通常与文献中的结果不一致，与不良结果相关的因素尚未得到充分研究。本研究的目的是确定与 Killip 3 级 AMI 患者院内死亡相关的因素。我们纳入了 205 名 Killip 3 级 AMI 患者，并将他们分为存活组 ( n = 189) 和院内死亡组 ( n = 16)。主要目的是使用多变量分析确定与院内死亡相关的因素。存活组的年龄显着低于住院死亡组（73.1 ± 11.2 岁 vs 83.2 ± 6.2 岁，P< 0.001)。存活组的收缩压 (SBP) 显着高于住院死亡组（150.0 ± 31.2 与 124.8 ± 25.3 mmHg，P = 0.002）。院内死亡组 TIMI ≥ 2 级血栓的发生率显着高于存活组（56.3% vs 22.2%，P = 0.005）。在多变量逻辑回归分析中，院内死亡与年龄显着相关 [优势比 (OR) 1.168，95% 置信区间 (CI) 1.061-1.287，P = 0.002] 和 TIMI 血栓等级 ≥ 2（相对于 ≤ 1：OR 5.743, 95% CI 1.717-19.214, P = 0.005)，与入院时 SBP 呈负相关（每增加 10 mmHg：OR 0.764，95% CI 0.613-0.953，P= 0.017）。总之，院内死亡与年龄和冠状动脉血栓负荷相关，与 Killip 3 级患者入院时的 SBP 呈负相关。认识到这些高风险特征对改善 Killip 患者的临床结果可能很重要3级。