Hospital outcome of moderate to severe pericardial effusion complicating ST-elevation acute myocardial infarction.
BACKGROUND
Hospital prognosis of moderate to severe pericardial effusion (MPE; ≥10 mm) in ST-elevation myocardial infarction is largely unknown.


RESULTS
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.


CONCLUSIONS
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.
Figueras
Jaume
J
Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 5751jfb@comb.es
Barrabés
José A
JA
Serra
Vicens
V
Cortadellas
Josefa
J
Lidón
Rosa-Maria
RM
Carrizo
Alvaro
A
Garcia-Dorado
David
D
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D002305:Cardiac Tamponade / Q000150:complications* / Q000401:mortality / Q000628:therapy; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology; D006342:Heart Rupture, Post-Infarction / Q000453:epidemiology; D006400:Hematocrit; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery / Q000628:therapy; D010490:Pericardial Effusion / Q000209:etiology* / Q000628:therapy; D010493:Pericarditis / Q000453:epidemiology; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome