Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes

Abstract

Pericardial effusion can dangerously precipitate patient’s hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010–2019). We enrolled 81 consecutive patients. Median age was 71.4 years (interquartile range [IQR] 58.1–78.1 years) and 51 (63%) were male. Most of the pericardiocentesis were performed in an urgency setting (76.5%) for cardiac tamponade (77.8%). The most common etiology was idiopathic (33.3%) followed by neoplastic (22.2%). In-hospital mortality was 14.8% while mortality during follow-up (mean 17.1 months) was 44.4%. Only hemodynamic instability (i.e., cardiogenic shock, hypotension refractory to fluid challenge therapy and inotropes) was associated with in-hospital mortality at the univariate analysis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.76–29.4). Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65–20.01, and OR 5.81, 95% CI 2.11–15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45–11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.

Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis

“…The high success rate of PCC and its low complication and recurrence rates in our large cohort of cancer patients shows the value of the percutaneous procedure, with continued drainage over a few days, as a first line therapy for large PEs in these patients. That PCC is associated with no significant delay in cancer treatment (surgery, chemotherapy, immunotherapy, or radiation therapy) further supports its use in this population ( 28 ).…”

Development and validation a simple scoring system to identify malignant pericardial effusion

“…MPE is diagnosed if the patient meets at least one of the following criteria: (1) tumor cells are detected in pericardial effusion cytology or pericardial biopsy; (2) proof of primary tumor; (3) atypical cells are detected in pericardial effusion and there is clinical evidence of tumor spread and exclusion of other potential causes of pericardial effusion ( 1 , 11 ).…”

Percutaneous Approach to Pericardial Disease Management

“…Although considered a high-risk procedure, complication rates for echocardiography guided or fluoroscopy guided percutaneous pericardiocentesis are low. Multiple large scale retrospective observational studies report total complication rates of up to 4.7-6.2% [12,27]. Importantly, procedural success rates are high.…”