Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis

Abstract

Abstract Background Percutaneous pericardiocentesis (PP) belongs to life-saving procedures in cardiac tamponade, while it may also serve as diagnostic procedure in patients with recurrent pericardial effusion. Purpose The aim of the study was to evaluate the clinical characteristics and predictors of in-hospital mortality among patients subject to PP. Methods This single-center retrospective study comprised consecutive patients who underwent PP between 2011 and 2021 regardless of primary diagnosis. Among 132 456 patients screened, 208 patients were subject to PP [109 women, 52.4%; median age of 66 (58; 76) years] who underwent 231 procedures. Exclusion criteria involved data incompleteness regarding the etiology and outcome. The primary endpoint was in-hospital mortality. Results The most common indications for PP were neoplastic disease (23.1%), idiopathic effusion (14.42%), coronary artery perforation during percutaneous coronary intervention (PCI; 13.9%), viral pericarditis (11.1%), cardiac electronic device implantation (10.6%), catheter ablation (8.7%) and post-pericardiotomy syndrome (5.8%). Overall, iatrogenic cause was the most common indication for PP (41.8%). The median volume of pericardial fluid was 550 (330; 850) ml. In-hospital death was reported in 11 patients (5.3%). Univariate analysis revealed that in-hospital death was predicted by PCI-related etiology (p<0.0001), history of pulmonary embolism (p=0.007) and sudden cardiac arrest (p=0.032), lower pericardial drainage volume (p=0.037), right bundle branch block (p=0.007), cardiogenic shock (p=0.003), packed red blood cells transfusion (p=0.023). Logistic regression indicated that PCI-related etiology (OR 76.1, p<0.001), history of pulmonary embolism (OR 17.9, p=0.03) and recurrent/persistent cardiogenic shock in the course of in-hospital stay (OR 14.7, p=0.004) were independently associated with in-hospital mortality (AUC 0.895; Figure 1). Conclusion Iatrogenic etiology represents the most frequent indication for PP. PCI-related coronary perforation confers the greatest risk of in-hospital death.