title: Effect of Pericardial Effusion Complicating ST-Elevation Myocardial Infarction as Predictor of Extensive Myocardial Damage and Prognosis.
abstract: Pericardial effusion (PE) is a common complication following ST-elevation myocardial infarction (STEMI). However, the frequency and prognostic relevance of PE complicating STEMI are unknown. Aim of this study was to investigate the exact incidence, infarct characteristics, and the prognostic impact of moderate-to-large PEs detected by cardiac magnetic resonance (CMR) in patients with acute reperfused STEMI. In total, 780 patients with STEMI reperfused by angioplasty (<12 hours after symptom onset) were enrolled in this CMR study at 8 centers. CMR was completed in median 3 days after infarction using a standardized protocol. Central core laboratory-masked analysis for the presence of moderate-to-large PE was performed. The primary clinical end point was the occurrence of major adverse cardiac events (MACE) defined as composite of all-cause death, reinfarction, and new congestive heart failure within 12 months after the index event. A moderate-to-large PE was detected in 183 patients (24%). Patients with moderate-to-large PEs had significantly larger infarcts, less myocardial salvage, a larger extent of microvascular obstruction, higher incidence of intramyocardial hemorrhage, and more pronounced left ventricular dysfunction (p <0.001 for all). Significant predictors of a moderate-to-large PE were age, Thrombolysis in Myocardial Infarction flow before percutaneous coronary intervention, and infarct size. MACE rates were significantly higher in the PE group (p = 0.003) and a moderate-to-large PE was identified as a significant independent predictor for MACE (hazard ratio 3.12, 95% confidence interval 1.49 to 6.81; p = 0.003) together with Thrombolysis in Myocardial Infarction risk score and left ventricular ejection fraction. In conclusion, a moderate-to-large PE complicating STEMI is a common finding (almost 25%) and related to more severe infarcts with subsequent significantly increased MACE rates during 1-year follow-up. Consequently, a moderate-to-large PE is a marker of poor outcome in patients with STEMI.
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Jobs
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Pöss
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. Electronic address: ingoeitel@gmx.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D002423:Cause of Death / Q000639:trends; D003331:Coronary Vessels; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D015994:Incidence; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D010490:Pericardial Effusion / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab