Prognostic relevance of pericardial effusion in STEMI patients treated by primary percutaneous coronary intervention: a 10-year single-centre experience. Issue 1 (7th November 2019)

• Record Type: Journal Article
• Authors: Albani, Stefano; Fabris, Enrico; Stolfo, Davide; Falco, Luca; Barbati, Giulia; Aquaro, Giovanni Donato; Vitrella, Giancarlo; Rakar, Serena; Korcova, Renata; Lardieri, Gerardina; Giannini, Francesco; Perkan, Andrea; Sinagra, Gianfranco
• Is Part Of: European heart journal. Volume 10:Issue 1(2021)
• Page Start: 71
• Page End: 80
• Publication Date: 2019-11-07
• Subjects: Primary PCI -- primary percutaneous coronary intervention -- myocardial infarction -- STEMI -- pericardial effusion -- free wall rupture -- cardiac magnetic resonance; 616.1205
• DOI: 10.1177/2048872619884858
• Languages: English
• ISSNs: 2048-8726

Abstract

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 per 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.