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.
Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 5751jfb@comb.es
Jaume
J
Figueras
José A
JA
Barrabés
Vicens
V
Serra
Josefa
J
Cortadellas
Rosa-Maria
RM
Lidón
Alvaro
A
Carrizo
David
D
Garcia-Dorado
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