| Objectives: To explore the clinical features and influencing factors ofpericardial effusion of patients with acute ST-segment elevation myocardialinfarction(STEMI) and to evaluate the predictive value of pericardialeffusion.Methods: From October2010to July2011,134consecutive patientswho suffered from STEMI within24hours from symptom onset were enrolledin this study. The STEMI was defined according to the guideline of ACC/AHAas electrocardiographic (ECG) ST-segment elevation at least two contiguousleads and elevated serum markers of myocardial necrosis greater than twicethe upper limit for creatine kinase or troponins with symptoms compatiblewith AMI for more than30minutes. Exclusion criteria were including majorsurgery or trauma within3months, contraindications of anticoagulation andantiplatelet therapy: hemorrhagic cerebrovascular accident, old cerebralhemorrhage or ischemic cerebrovascular accident within6months, withbleeding disorder or thrombocytopenia, allergic to aspirin and contrast agents,serious liver or renal function impairment. All the patients were ungerwentheart ultrasound by VIVID-7heart Doppler echocardiography instrument onthe third day after admission. According to pericardial effusion, all the eligiblepatients were divided into two groups: group A (with pericardial effusiongroup) and group B (non pericardial effusion group). Patients in group A werefurther divided into two groups: Group1with mild pericardial effusion andGroup2with moderate or severe pericardial effusion. The left ventricular enddiastolic volume (LVEDV), left ventricular end systolic volume (LVESV) andcalculation left ventricular ejection fraction (LVEF) were measured;application method of visual wall motion (WMSI) for qualitative analysis, wall motion score index for semi-quantitative analysis. LVEDV, LVEF, WMSIwere recorded and compared between the two groups. Echocardiogram wasrepeated1month and6months after infarction. Patients within12hours fromsymptom onset were done fibrinolytic therapy or primary PCI. All patientswere received coronary angiography in our hospital, and the quantitativecoronary analysis (QCA) was used to measure the characteristics of IRA.Patients with beyond75%luminal stenosis measured by QCA were implantedstents. Stents were implanted if the stenosis of IRA was more than75%. Drugeluting stents are chosen in all the patients. Another angiography was doneafter5minutes of stent implanted. The IRA distribution and TIMI flow of IRAbefore and after PCI were compared between the two groups. Killipclassification was examined by two experienced doctors on admission. Samplefrom each patient was analyzed for total protein, albumin and globulin.Myocardial enzymes were dynamically measured after admission within2days, and the peak value of CKMB were compared. Clinical characteristics,including age, gender distribution, infarction area, histories of hypertensionand diabetes were recorded and compared. Major adverse cardiac events(MACE) which were including psychogenic death, serious heart failure,non-fatal myocardial infarction again, malignant arrhythmia and target-vesselrevascularization were recorded after6-mnonth follow up. Aspirin,clopidogrel, low molecular weight heparin and other drugs were used ascurrent practice guidelines. All data were analyzed by SPSS13.0software, andP <0.05was considered as a significant difference.Results: There is no statistical differences between the two groups in age,gender, hypertension, diabetes, history of old myocardial infarction, currentsmoking, and family history (all P>0.05). Blood glucose, blood lipids(including CHOL, HDL, LDL, TG), total protein, albumin, globulin, the levelof kidney (BUN, CREA) at admission were similar (all P>0.05).There wereno statistical difference between the two groups in underlying drug use (P>0.05).So did to the subgroup of group A. The proportion of patients whoreceived early reperfusion therapy in Group A was lower than that group B (P =0.013). Early reperfusion therapy proportion of subgroup was with nosignificant difference (P <0.05). The proportion of patients with anteriormyocardial infarction in Group A was higher than that in group B (61.3%vs38.8%, P <0.05).The patients of group A with a larger myocardialinfarction area. The CKMB peak levels of group A were obviously higher thanthose of the control group (234.84±149.16vs.101.4±54.52U/L, P<0.05).TheCKMB peak levels of subgroup2were obviously higher than those insubgroup1. The IRA between the two groups was significant difference (P <0.05).Group A had higher proportion of patients with the lesion of IRA (51.6%vs.30.1%, P<0.05). Group B had higher proportion of patients with the lesionof RCA (29%vs.52.42%, P<0.05). Patients with lesion of LCX were nostatistically different between the two groups. Subgroup1had higherproportion of patients with the lesion of RCA. Compared to control group, theproportion of patients with IRA total occlusion before stent implantation wasmuch higher (67.74%vs.26.21%,P<0.05) and the proportion of patient withTIMI2grade before stent implantation was much lower (9.68%vs.44.66,P<0.05).There was no significant difference in the rates of IRA TIMI flowgrade1and TIMI flow grade3before stent implantation between the twogroups(P>0.05).After stent implantation, no significant differences in TIMIflow were found between the two groups(P>0.05).The rate of no flow was nosignificant difference (P>0.05). There was no difference in the incidence ofthe preoperative and postoperative TIMI and no-reflow between the twosubgroups of group A (P>0.05). Compared to group B, left ventricular wallmotion and systolic function of group A was poor. Echocardiography at3daysafter admission showed that LVEF (48.17±11.34vs.56.23±8.55%, P=0.01),WMSI (2.23±0.41vs.1.57±0.3, P<0.05), LVEDV (147±35.57vs.126.2±31.09U/L, P=0.02). Echocardiography at1month post infarctionshowed that LVEF (51.45±9.54vs.60.19±6.3%, P<0.05), WMSI (2.06±0.35vs.1.3±0.15, P<0.05), LVEDV (134.48±24.33vs.126.87±31.28ml,P>0.05).Echocardiography at6month after infarction showed that LVEF (54.23±7.21vs.62.2±7.37%, P<0.05), WMSI (1.65±0.33vs.1.21±0.08, P<0.05), LVEDV(127.63±17.93vs.121.97±24.79, P>0.05).Left ventricular wall motionand systolic function of the two groups of patients have significantly improved.LVEF of subgroup2, whether it is in the hospital or at6months follow-upperiod were lower than the subgroup1(P<0.05).In follow-up period, subgroup2had higher LVEDV than subgroup1(P<0.05). Group A subgroup WMSIduring the observation period, there was no significant difference(P>0.05).Compared to group A, the proportion of patient with Killip grade1on admission was much higher (76.75vs.41.94%，P<0.05). No significantdifferences were found about the Killip grade between the two subgroups. Theincidence of severe heart failure was higher in group A, while recurrentnonfatal myocardial infarction, cardiac death, target vessel revaslarization,malignant arrhythmias,cardiac rehospitalization were similar. Subgroup2with high proportion of severe heart failure (44.44%vs.4.54%,P=0.017)andhigher cardiac rehospitalization rate (55.56vs.13.64, P=0.027).Conclusions:1Effective early reperfusion therapy could markedly reduce the incidence ofthe pericardial effusion.2The clinical features of STEMI patients with pericardial effusion: highproportion of anterior myocardial infarction; the high incidence of IRA totallyoccluded LAD; large myocardial infarction; the peak of enzyme significantlyincreased; the motion of left ventricular regional wall reduce and ejectiondysfunction.3The occurrence of pericardial effusion increased the possibility of STEMIpatients with severe heart failure, MACE events and cardiac readmission ratesdid not increase. The amount of pericardial effusion indicates a higher cardiacrehospitalization rate. |
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