Hospital Outcome of Moderate to Severe Pericardial Effusion Complicating ST-Elevation Acute Myocardial Infarction

• Published in: Circulation (New York, N.Y.) Vol. 122; no. 19; pp. 1902 - 1909
• Main Authors: Figueras, Jaume, Barrabés, José A., Serra, Vicens, Cortadellas, Josefa, Lidón, Rosa-Maria, Carrizo, Alvaro, Garcia-Dorado, David
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 09.11.2010
• Subjects: Aged; Aged, 80 and over; Atrial Fibrillation - epidemiology; Biological and medical sciences; Blood and lymphatic vessels; Cardiac Tamponade - complications; Cardiac Tamponade - mortality; Cardiac Tamponade - therapy; Cardiology. Vascular system; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Heart Injuries - epidemiology; Heart Rupture, Post-Infarction - epidemiology; Hematocrit; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocardial Infarction - therapy; Pericardial Effusion - etiology; Pericardial Effusion - therapy; Pericarditis - epidemiology; Prognosis; Survival Rate; Treatment Outcome; Myocardial infarction; Prognosis; death; Cardiac tamponade; Rupture; Cardiovascular disease; Sudden; Coronary heart disease; Myocardial disease; ST elevation; cardiac rupture; Pericardial Effusion; Pericardial disease
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.109.934968

Hospital prognosis of moderate to severe pericardial effusion (MPE; ≥10 mm) in ST-elevation myocardial infarction is largely unknown. Data from 446 ST-elevation myocardial infarction patients, 228 with MPE-88 with cardiac tamponade (CT) and electromechanical dissociation (EMD), 44 with CT without EMD (w/oEMD), and 96 without initial CT-and 218 with small PE (5 to 9 mm), were compared. Patients with MPE without initial CT were also compared with 96 patients without PE. CT patients showed larger PE (P<0.001) than those without initial CT; 85% of those with CT+EMD and 86% with CTw/oEMD were treated with pericardiocentesis and 10% and 21% were treated with a surgical repair, respectively. Among MPE patients, 30-day mortality was 43% and was higher in those with CT+EMD (operated, 89%; and nonoperated, 85%) than in those with CTw/oEMD (22% and 11%, respectively; P<0.001) and those without initial CT (17%; P<0.001). It was also higher than in patients with small PE (10%; P<0.001) or those without PE (6%; P=0.001). Death was attributable to cardiac rupture in 83% of patients with CT+EMD, 7% with CTw/oEMD, and 8% with MPE without initial CT and occurred late (≥7 days) in 14%, 67%, and 100%, respectively. MPE carries an increased mortality that is highest in patients with CT+EMD. In those with CTw/oEMD, however, mortality is considerably low after pericardiocentesis, and subsequent management may be individualized because a conservative approach is often successful. Importantly, MPE patients without initial CT are not free from late rupture and deserve further investigation.