Pericardiocentesis Outcomes in Patients With Pulmonary Hypertension: A Nationwide Analysis from the United States

Abstract

Pericardiocentesis (PC) in patients with Pulmonary Hypertension (PH) and pericardial effusions has unclear benefits as it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population is limited. The National Inpatient Sample database was used to identify adult patients undergoing PC during hospitalizations between 2016 and 2020. Data was stratified by the presence or absence of PH. A multivariate regression model and case-control matching was used to estimate the association of PH with PC in-hospital outcomes. A total of 95,665 adults with a procedure diagnosis of PC were included, of which 7,770 had PH. Patients with PH tended to be older (67 ± 15.7) and female (56%), less frequently presented with tamponade (44.9% vs 52.4%). Patients with PH had significantly higher rates of CKD, coronary artery disease, heart failure, chronic lung disease, among other comorbidities. In the multivariate analysis, PC in PH was associated with higher all-cause mortality (aOR 1.40; CI: 1.30-1.51) and higher rates of post-procedure shock (aOR 1.53; CI: 1.30-1.81) compared to patients without PH. Mortality was higher among those with Pulmonary Arterial Hypertension (PAH) compared to other non-PAH PH groups (aOR 2.35, 95% CI: 1.46-3.80, p <0.001). Rates of cardiogenic shock (aOR: 1.49; 95% CI: 1.38-1.61), acute respiratory failure (aOR: 1.56; 95% CI: 1.48-1.64), and mechanical circulatory support use (aOR 1.86; 95% CI: 1.63-2.12) were also higher in patients with PH. There was no significant volume-outcome relationship between hospitals with high per annum pericardiocentesis volume compared to low volume hospitals in these patients. In conclusion, PC is associated with increased in-hospital mortality and higher rates of cardiovascular complications in patients with PH, regardless of WHO PH group.