Myocardial infarction: cardiac tamponade was rare.

Clinical bottom line (level 4)

  1. About 1% of patients who have had thrombolytic therapy after an acute myocardial infarction had cardiac tamponade.
Renkin et al: Journal of the American College of Cardiology 1991; 17 (1): 280-285
Expires March 2003

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: coronary care unit, Belgium

392 patients (aged ?, ?% male) acute myocardial infarction treated with thrombolytic therapy

Excluded if
  • haemopericardium after rupture from thrombolysis


Patients were given any of: streptokinase intracoronary (250,000 IU), streptokinase intravenously (500,000 or 1,500,000 IU), 30 mg anisoylated plasminogen streptokinase activator complex intravenously or 100 mg recombinant tissue-type plasminogen activator intravenously. All patients were given heparin before and during thrombolysis. Analgesics and nitroglycerin or isosorbide dinitrate infusions could also be given. Aspirin was given when heparin infusion was discontinued.

100 followed for 24 hours
Outcomes studied:
  • cardiac tamponade (documented primary haemorrhagic pericardial effusion, evolving in <24 hours to a clinical and haemodynamic syndrome of cardiac tamponade)

The evidence

outcome time to outcome number of patients/total number %
(95% CI)
cardiac tamponade 24 hours 4/392 1.0%
(0.3% to 2.6%)

Comments

  1. The authors suggest this complication may be routinely missed, and death reported as myocardial rupture or cardiogenic shock.

Citation

  1. Renkin J, De Bruyne B, Benit E, et al: Cardiac tamponade early after thrombolysis for acute myocardial infarction: A rare but not reported hemorrhagic complication. Journal of the American College of Cardiology 1991; 17 (1): 280-285
Contributor: Clare Wotton and Bob Phillips, January 2000
Reviewer:

Clinical Question.
Patient myocardial infarction
Intervention or Exposure thrombolysis
Outcome cardiac tamponade