Pericardial effusion in acute Myocardial Infarction: frequency and in-hospital course

Abstract

Objective: To determine the frequency and in-hospital course of pericardial effusion in acute myocardial infarction in our population. Design: Prospective observational study. Place of Study: The study was conducted in the Department of Cardiology and Medicine, Mayo Hospital, Lahore. Patients and methods: One hundred consecutive patients presented within first 24 hours of first episode of ST elevation myocardial infarction (STEMI) were studied. Patients with known coronary artery disease (CAD), chronic renal failure, collagen vascular disease, cardiac surgery and metastatic disease were excluded from the study. 2-D and M-mode echocardiographic examination was carried out daily and pericardial effusion (PE) was considered to be present when separation between two pericardial layers persisted throughout the cardiac cycle. Results: Among 100 patients who were enrolled, 27 developed PE. Frequency of baseline variable like age, gender, and risk factors for coronary artery disease including hypertension, smoking, and diabetes mellitus were same in patients who developed PE when compared to those who did not. Most of the PE was detected on day 5 of the admission. About 82 % patients had mild PE (only posteriorly and <10 mm). Moderate PE was detected in 18% (present all around and between 10-20 mm). None of the patients developed large PE (>20 mm). About 15 % patients who were thrombolysed and 40% who could not be thrombolysed developed PE (p < 0.01). Frequency of PE was statistically highly significant (p <0.001) among patients with higher Killip class and lower ejection fraction at the time of presentation. Patients who developed PE had statistically significant longer hospital stay (p <0.001) and higher in-hospital mortality (p < 0.05). Conclusion: Thrombolysis decreased the frequency of PE in acute STEMI. Development of PE during the course of acute STEMI has prognostic implications and early invasive strategy may be offered for patients who develop this complication.