Delayed occurrence of cardiac tamponade following percutaneous coronary intervention for ST-segment elevation myocardial infarction

Objective To analysis the clinical characteristics, early diagnosis, management and outcome of patients with ST-segment elevation coronary infarction (STEMI) complicated by delayed cardiac tamponade after primary percutaneous cardiac intervention (PPCI) . Methods A cohort of consecutive 503 STEMI patients after PCI admitted between August 2011 and March 2014 were analyzed, and the diagnosis of cardiac tamponade was confirmed in 3 patients (0.6%) . Results Three cases of cardiac tamponade were found in the period of 18 -54 h after STEMI and in the period of 14 -46 h after PPCI. All of the cases were of anterior wall AMI resulted from left anterior descending (LAD) stenosis. The initial symptom of two cases was sudden fall of blood pressure, while the other one was chest pain experienced during breathing and audible pericardium friction sound. All of the three cases received pericardiocentesis and drainage under sonographic guidance with retention of drainage for 2 -3 days, and all were healed after aforesaid treatments. Conclusions Cardiac tamponade usually occurs in 72 h after STEMI, and constant vigilance to the complication of PCI by strengthening the awareness of diagnosis, identifying the early clinical characteristics and rapid examinations with bedside sonography was the key in prompt diagnosis of cardiac tamponade. Timely pericardiocentesis and drainage could improve outcome. Key words: ST-Segment elevation myocardial infarction; Primary percutaneous cardiac intervention; Cardiac rupture; Cardiac tamponade; Delayed