Format

Send to

Choose Destination
Eur Heart J Acute Cardiovasc Care. 2019 Nov 7:2048872619884858. doi: 10.1177/2048872619884858. [Epub ahead of print]

Prognostic relevance of pericardial effusion in STEMI patients treated by primary percutaneous coronary intervention: a 10-year single-centre experience.

Author information

1
Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy.
2
Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy.
3
Department of Cardiology, Fondazione Toscana G Monasterio, Pisa, Italy.
4
Department of Cardiology, Azienda per l'Assistenza Sanitaria n 2 Bassa Friulana-Isontina, Gorizia, Italy.
5
Department of Cardiology, Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Ravenna, Italy.

Abstract

BACKGROUND:

Pericardial effusion is frequent in the acute phase of ST-segment elevation myocardial infarction. However, its prognostic role in the era of primary percutaneous coronary intervention is not completely understood.

METHODS:

We investigated the association between pericardial effusion, assessed by transthoracic echocardiography, and survival in a large cohort of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention, enrolled in the Trieste primary percutaneous coronary intervention registry from January 2007 to March 2017. Multivariable analysis and a propensity score approach were performed.

RESULTS:

A total of 1732 ST-segment elevation myocardial infarction patients were included. Median follow-up was 45 (interquartile range 19-79) months. Pericardial effusion was present in 246 patients (14.2%). Thirty-day all-cause mortality was similar between patients with and without pericardial effusion (7.8% vs. 5.4%, P=0.15), whereas crude long-term survival was worse in patients with pericardial effusion (26.2% vs. 17.7%, P≤0.01). However, at multivariable analyses the presence of pericardial effusion was not associated with long-term mortality (hazard ratio 1.26, 95% confidence interval 0.86-1.82, P=0.22). Matching based on propensity scores confirmed the lack of association between pericardial effusion and both 30-day (hazard ratio 1, 95% confidence interval 0.42-2.36, P=1) and long-term (hazard ratio 1.14, 95% confidence interval 0.74-1.78, P=0.53) all-cause mortality. Patients with pericardial effusion experienced a higher incidence of free wall rupture (2.8% vs. 0.5%, P<0.0001) independently of the entity of pericardial effusion.

CONCLUSIONS:

In acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, the onset of pericardial effusion after ST-segment elevation myocardial infarction is not independently associated with short and long-term higher mortality. Free wall rupture has to be considered rare compared to the fibrinolytic era and occurs more frequently in patients with pericardial effusion, suggesting a close monitoring of these patients in the early post-primary percutaneous coronary intervention phase.

KEYWORDS:

Primary PCI; STEMI; cardiac magnetic resonance; free wall rupture; myocardial infarction; pericardial effusion; primary percutaneous coronary intervention

PMID:
31696727
DOI:
10.1177/2048872619884858

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center