Diagnosis and management of 15 cases of acute cardiac tamponade complicating percutaneous coronary intervention

Objective Cardiac tamponade is an uncommon but life-threatening complication of percutaneous coronary intervention (PCI).The purpose of the present study was to characterize the diagnosis,management and clinical outcome associated with this complication.Methods A retrospective database of 2 326 PCIs performed at Xijing hospital between February 1992 and May 2003 was analyzed.Cardiac tamponade was observed in 15 of 2 326 PCI procedures(0.64%).Cardiac tamponade was diagnosed according to the following clinical findings:mania,low blood pressure,bradycardia,cardiac enlargement under fluoroscopy and a moderate or large pericardial effusion by echocardiogram.In addition to general rescue and therapeutics,pericardiocentesis was performed,and filling balloon,coated stents or further emergency surgical intervention were required in some cases.Results Cardiac tamponade was diagnosed in the catheterization laboratory in eight of 15 patients,and seven patients had a delayed presentation(mean time from PCI 4.5 hours).Pericardiocentesis was performed in the 15 patients;eight patients were treated successfully with aspiration alone,but four patients required filling balloon or coated stents and three patients required further emergency surgical intervention.Six patients adopted routine pericardiocentesis in which four succeeded;Nine patients adopted central venous catheter insertion in which eight succeeded. Conclusion Immediate echocardiography and X-ray examination are essential measures to diagnose and treat promptly the acute cardiac tamponade complicating PCI.Pericardiocentesis is the first choice to treat acute cardiac tamponade,and venous catheter insertion is another prompt,safe and accurate method.The use of filling balloon,coated stents or surgical intervention may provide valuable rescue options for this serious complication.