title: Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. The TAMI Study Group.
abstract: To evaluate the clinical incidence and outcomes of patients with pericarditis after thrombolytic therapy, 810 patients were prospectively studied during acute myocardial infarction (AMI). Pericarditis was defined as the presence of a pericardial friction rub during the hospital course. Only 5% of patients developed a rub during AMI, a low percent compared with that in the prethrombolytic era. A pericardial friction rub more often occurred in the setting of an anterior wall AMI. Patients with, compared to those without, a pericardial friction rub had lower ejection fractions (45 vs 51%, p = 0.002); worse regional left ventricular function (-3.2 vs 2.7, standard deviation per chord); higher in-hospital mortality (15 vs 6%, p = 0.056); a higher frequency of power failure (83 vs 57%); a higher frequency of anterior wall location of the AMI (53% of cases, p = 0.002); and a higher frequency of 3-vessel disease. Therefore, although the frequency of a pericardial friction rub was low (5%) compared with that in the prethrombolytic era, its occurrence denotes more extensive myocardial damage with a worse clinical outcome. Perhaps with successful reperfusion of the infarct-related vessel, transmural myocardial necrosis is prevented and with it the development of pericarditis. Cardiac tamponade did not occur clinically in any patient who developed a pericardial friction rub.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: T C
authors.initials: TC
authors.lastname: Wall
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: L
authors.initials: L
authors.lastname: Harrelson-Woodlief
authors.forename: D B
authors.initials: DB
authors.lastname: Mark
authors.forename: M
authors.initials: M
authors.lastname: Honan
authors.forename: C W
authors.initials: CW
authors.lastname: Abbotsmith
authors.forename: R
authors.initials: R
authors.lastname: Candela
authors.forename: E
authors.initials: E
authors.lastname: Berrios
authors.forename: H R
authors.initials: HR
authors.lastname: Phillips
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D005260:Female; D006326:Heart Auscultation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010493:Pericarditis / Q000175:diagnosis* / Q000453:epidemiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator