title: Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes.
abstract: BACKGROUND
  Cardiac tamponade is a life-threatening state that complicates various medical conditions. The contemporary interventional era may have led to changes in clinical characteristics, causes and outcomes of cardiac tamponade.
  
  
  METHODS
  We investigated all patients diagnosed with cardiac tamponade, based on clinical and echocardiographic findings, at a single medical center between the years 2000 and 2013. Data on medical history, index hospitalizations, pericardial fluid etiologies, and acute and long-term outcomes were collected.
  
  
  RESULTS
  Cardiac tamponade was observed in 83 patients (52% females). Major etiologies included complications of percutaneous cardiac interventions (36%) and malignancies (primarily lung cancer; 23%), infectious/inflammatory causes (15%) and mechanical complications of myocardial infarction (12%). Sixteen (19%) patients died during the index hospitalization. Acute presentation of symptoms and lower quantity of effusion were associated with in-hospital mortality (p = 0.045 and p = 0.007). Tamponade secondary to malignancy was associated with the most substantial increment in post-discharge mortality (from 16% in-hospital to 68% 1-year mortality). During the mean follow-up of 45 months, 39 (45%) patients died. Malignancies, mechanical complications of myocardial infarction and bleeding/coagulation abnormalities were etiologies associated with poor survival (80% mortality during follow-up). Tamponade secondary to complications of percutaneous cardiac interventions or infectious/inflammatory causes were associated with significantly lower mortality (28% and 17%; log rank p < 0.001).
  
  
  CONCLUSIONS
  In a contemporary cohort, complications of percutaneous cardiac intervention replaced malignant diseases as the leading cause of cardiac tamponade. Nevertheless, these iatrogenic complications were associated with a relatively favorable outcome compared to tamponade induced by complications of myocardial infarction, coagulation abnormalities and malignant diseases.
authors.forename: Ady
authors.initials: A
authors.lastname: Orbach
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Schliamser
authors.forename: Moshe Y
authors.initials: MY
authors.lastname: Flugelman
authors.affiliation: Carmel Medical Center, Hiafa, Israel. barakzmd@gmail.com.
authors.forename: Barak
authors.initials: B
authors.lastname: Zafrir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiac tamponade; outcome; procedural complications