ABSTRACT
Background: Percutaneous pericardiocentesis represents a salvage procedure in case of cardiac tamponade and diagnostic procedure in chronic pericardial effusion of unknown source. The study aimed to analyze the clinical characteristics of patients subject to pericardiocentesis and the predictors of in-hospital mortality. Methods: The study represents a registry that covered consecutive patients undergoing percutaneous pericardiocentesis from 2011 to 2022 in high-volume tertiary reference center. Electronic health records were queried to obtain demographic and clinical variables. The primary endpoint was in-hospital mortality, while secondary endpoint was the need for recurrent pericardiocentesis. Results: Out of 132 456 patients hospitalized in the prespecified period, 247 patients were subject to percutaneous pericardiocentesis (53.9% women; median age of 66 years) who underwent 273 procedures. In-hospital death was reported in 14 patients (5.67%), while recurrent pericardiocentesis in 24 patients (9.72%). Iatrogenic cause was the most common etiology (42.5%), followed by neoplastic disease (23.1%) and idiopathic effusion (14.57%). In logistic regression analysis in-hospital mortality was associated with myocardial infarction (MI)-related etiology (p = 0.001) and recurrent/persistent cardiogenic shock (p = 0.001). Conclusions: Iatrogenic etiology and neoplastic disease seem to be the most common indications for pericardiocentesis, while in-hospital mortality was particularly high in patients with spontaneous tamponade in the course of MI.
ABSTRACT
Introduction: Small vessel disease (SVD) usually refers to atherosclerosis within vessels of diameter of < 2.5 mm. Conflicting data exist regarding the outcomes of its revascularization. Aim: To evaluate the outcome of invasive treatment in patients with acute coronary syndromes (ACS) and SVD and the predictors of angina recurrence after percutaneous coronary intervention (PCI). Material and methods: This was an observational, retrospective, single-center study. It covered consecutive 127 patients (26.77% women; median age: 69.74 ±8.97 years) with ACS who underwent PCI in the Upper-Silesian Medical Center in Katowice between 2018 and 2020. The study population was stratified by means of presence of SVD defined by PCI of the culprit artery with a diameter of ≤ 2.5 mm. The major adverse cardiac and cerebrovascular events (MACCE) and angina recurrence were analyzed in a 12-month follow-up period. Results: Overall 99 (77.95%) patients were diagnosed with small-vessel coronary artery disease. MACCE were documented in 14 (11.02%) patients. Univariate analysis revealed the following factors associated with MACCE: left ventricle ejection fraction (LVEF) (OR = 0.95, p = 0.0212), left main (LM) stenting (OR = 18.17, p = 0.0216), number of former PCIs (OR = 1.48, p = 0.0235). According to logistic regression analysis the factors were LM stenting (OR = 20.04, p = 0.0216) and number of former PCIs (OR = 1.53, p = 0.0203). Patients with SVD had more often refractory or recurrent angina in symptomatic class III/IV on follow-up (52.53% vs. 10.71%, p < 0.001). Conclusions: Outcome of invasive treatment in patients with ACS is related to LM stenting and former PCIs but not to SVD occurrence. Patients with SVD have a high rate of recurrent/refractory angina despite successful PCI in this clinical setting.
