Hospital outcome of moderate to severe pericardial effusion complicating st-elevation acute myocardial infarction

Jaume Figueras, José A. Barrabés, Vicens Serra, Josefa Cortadellas, Rosa Maria Lidón, Alvaro Carrizo, David Garcia-Dorado

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42 Citations (Scopus)

Abstract

Background-: Hospital prognosis of moderate to severe pericardial effusion (MPE; ≥10 mm) in ST-elevation myocardial infarction is largely unknown. METHODS AND 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. © 2010 American Heart Association, Inc.
Original languageEnglish
Pages (from-to)1902-1909
JournalCirculation (New York, N.Y.)
Volume122
Issue number19
DOIs
Publication statusPublished - 9 Nov 2010

Keywords

  • cardiac rupture
  • cardiac tamponade
  • death, sudden
  • myocardial infarction
  • pericardial effusion

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