Nature and progression of pericardial effusion in patients with a first myocardial infarction: relationship to age and free wall rupture.
BACKGROUND
Left ventricular free wall rupture (FWR) usually develops within the first days of acute myocardial infarction (AMI) without warning, but it is uncertain whether a mild pericardial effusion might herald this complication.


METHODS
A 2-dimensional echocardiogram (2DE) was performed in patients with first AMI with (1149) or without (324) ST-segment elevation within 2 days. A second 2DE was performed 2 to 4 days later in 300 patients, 100 with and 200 without an initial mild PE (3-9 mm), and in those with initial moderate-severe PE (> or =10 mm) (MSPE) or who developed hypotension or died.


RESULTS
The first 2DE showed mild PE in 177 patients and MSPE in 51 patients, whereas a late (>2 days) MSPE occurred in 27 with a second routine 2DE, 15 (15%) with and 12 (6%) without initial mild PE (P =.01). Fourteen additional patients, 5 of 77 (6%) with and 9 of 1045 (1%) without initial PE, presented with hypotension and late MSPE (P <.002). Of 92 patients with MSPE, 90 had ST-segment elevation (98%), 60 had tamponade (65%), and 38 died of FWR or were operated on (41%). Results of pericardiocentesis performed in 64 patients were positive in 58, with hemopericardium in 57 (98%). Multivariant analysis showed mild PE on first 2DE and age of >60 years as the only independent predictors of late MSPE or late tamponade.


CONCLUSIONS
Mild PE within the first 2 days in patients aged >60 years with a first ST-segment elevation AMI is associated with an increased risk of late MSPE. Moreover, in this setting MSPE is most frequently associated with hemopericardium, and two thirds of these patients may develop tamponade/FWR.
Unitat Coronaria, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. j.figueras@jet.es
Jaume
J
Figueras
Alberto
A
Juncal
Julio
J
Carballo
Josefa
J
Cortadellas
Jordi Soler
JS
Soler
D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D016002:Discriminant Analysis; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology*; D010490:Pericardial Effusion / Q000175:diagnosis / Q000453:epidemiology*; D020519:Pericardiocentesis; D010493:Pericarditis / Q000453:epidemiology; D011446:Prospective Studies