Cardiac tamponade in the fibrinolytic era: analysis of >100,000 patients with ST-segment elevation myocardial infarction.
BACKGROUND
Cardiac tamponade is a life-threatening complication of acute myocardial infarction (MI). Data on the incidence, risk factors, and outcome of tamponade in patients with acute MI in the fibrinolytic era are limited.


METHODS
Data from a combined clinical trials database of ST-segment elevation MI were used to evaluate the incidence of cardiac tamponade, baseline characteristics, and outcomes in patients with and without tamponade. Univariable and multivariable analyses assessed the relationship between patient characteristics and tamponade development, and the influence of tamponade on mortality.


RESULTS
Of 102,060 patients, 865 (0.85%) developed isolated cardiac tamponade during initial hospitalization. Patients with tamponade were older (median 71.9 vs 61.6 years, P < .001), were more likely to be female (54.0% vs 25.1%, P < .001), were more likely to have an anterior MI (61.9% vs 41.5%, P < .001), and had a longer time from symptom onset to reperfusion (median 3.5 vs 2.8 hours, P < .001) than those without tamponade. Multivariable analyses identified increasing age, anterior MI location, female sex, and increased time from symptom onset to treatment as significant independent predictors of tamponade. Patients with tamponade had an increased death rate at 30 days (hazard ratio 7.9, 95% CI 4.7-13.5).


CONCLUSIONS
Cardiac tamponade occurs in < 1% of patients with fibrinolytic-treated acute MI and is associated with increased 30-day mortality. Time from symptom onset to treatment strongly predicted the development of tamponade, underscoring the need for continued efforts to increase speed to treatment in acute MI.
Patel
Manesh R
MR
Duke Clinical Research Institute, Durham, NC 27715, USA.
Meine
Trip J
TJ
Lindblad
Lauren
L
Griffin
Jeffrey
J
Granger
Christopher B
CB
Becker
Richard C
RC
Van de Werf
Frans
F
White
Harvey
H
Califf
Robert M
RM
Harrington
Robert A
RA
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002305:Cardiac Tamponade / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D017023:Coronary Angiography; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000473:pathology; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents