Myocardial infarction: pericardial rub was related to poor prognosis.

Clinical bottom line (level 4)

  1. In patients with acute myocardial infarction, the presence of a pericardial rub during hospitalisation was associated with a worse in-hospital prognosis (NNF = 4 for unknown) .
  2. Patients with acute myocardial infarction and pericardial rub were unlikely to go into significant pericarditis or tamponade.
Wall et al: American Journal of Cardiology 1990; 66: 1418-1421
Expires March 2003

The study

Prospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital in North America

810 patients (aged mean 57y (range 46y to 65y), 80% male) acute myocardial infarction diagnosed by symptoms >30 mins, ST elevation >1mm in >2 contiguous leads

Excluded if
  • >6 hours after MI onset
  • >75 years old
  • bleeding diathesis
  • absence of cardiogenic shock
  • no prior CABG



    • Factors studied:
  • pericardial rub
  • pericardial rub


    • Given thrombolysis; lignocaine, oxygen and morphine; nitrates, heparin, calcium-channel blockers and aspirin; beta-blockers not routinely used.

    Simple comparison of survival data.

    ?100% followed for hospitalisation
    Outcomes studied:
  • in-hospital mortality
  • clinically significant pericardial effusion or tamponade

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    in-hospital mortality hospitalisation 55/810 6.79%
    (5.06% to 8.52%)
    clinically significant pericardial effusion or tamponade hospitalisation 0/810 0.00%
    (0% to 0.4%)

    prognostic factor for
    in-hospital mortality     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    pericardial rub hospitalisation 2.36
    (1.07 to 5.17)     		12
    (4 to 210)

    prognostic factor outcome present outcome absent unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    pericardial rub 6 14 2.36
    (1.07 to 5.17)     		12
    (4 to 210)
    no pericardial rub 46 744

    Comments

    1. No control for any other important prognostic variable places doubt on overall significance.

    Citation

    1. Wall TC, Califf RM, Harrelson-Woodlief L, et al: Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. American Journal of Cardiology 1990; 66: 1418-1421
    Contributor: Bob Phillips and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient hospitalised with AMI
    Intervention or Exposure physical examination revealing pericardial rub
    Outcome in hospital mortality