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Pericardial effusion after intravenous recombinant tissue-type plasminogen activator for acute myocardial infarction
R N Belkin1, D B Mark, L Aronson
1Division of Cardiology, New York Medical College, Valhalla.
Insights
Thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) did not alter the frequency or time course of pericardial effusion after myocardial infarction. Adverse outcomes from this effusion are rare in patients receiving rt-PA.
Area of Science:
- Cardiology
- Medical Imaging
- Pharmacology
Background:
- Pericardial effusion following myocardial infarction is a known complication.
- The impact of thrombolytic therapy on pericardial effusion is not well understood.
- Recombinant tissue-type plasminogen activator (rt-PA) is a common thrombolytic agent.
Purpose of the Study:
- To investigate the effect of rt-PA on the incidence, timing, and complications of pericardial effusion post-myocardial infarction.
- To compare echocardiographic findings in patients receiving rt-PA with historical data.
Main Methods:
- Prospective, serial 2-dimensional echocardiographic study.
- 52 patients with myocardial infarction receiving rt-PA.
- Echocardiograms performed at baseline (day 0) and days 1, 3, and 6 post-therapy.
Main Results:
- Pericardial effusion prevalence: 8% (day 0), 5% (day 1), 19% (day 3), 24% (day 6).
- No cases of cardiac tamponade were observed.
- The prevalence and time course of effusion were similar to patients not receiving thrombolytic therapy.
Conclusions:
- Thrombolytic therapy with rt-PA does not appear to significantly affect the occurrence or progression of pericardial effusion after myocardial infarction.
- Pericardial effusion following rt-PA therapy for myocardial infarction rarely leads to adverse sequelae like cardiac tamponade.
Abstract:
The effect of thrombolytic therapy on the frequency, time course and sequelae of pericardial effusion after myocardial infarction are unknown. A prospective, serial, 2-dimensional echocardiographic study of patients with myocardial infarction who received recombinant tissue-type plasminogen activator (rt-PA) was undertaken to address this issue. The study population comprised 52 of the 112 patients enrolled in the first Thrombolysis and Angioplasty in Myocardial Infarction trial at Duke University Medical Center. Enrollment in the serial echocardiography protocol was determined by equipment and support staff availability. Complete echocardiographic studies were performed within 90 minutes after initiation of thrombolytic therapy (day 0), and on days 1, 3 and 6. Patients undergoing serial echocardiography did not differ in demographic or clinical characteristics from those who did not. Pericardial effusion was present in 3 of 38 patients (8%) at day 0, in 2 of 44 (5%) at day 1, in 8 of 43 (19%) at day 3, and in 10 of 42 (24%) at day 6. By day 6, 3 of 10 pericardial effusions were moderate in size, 1 of 10 was large and the remainder were small. No patients developed echocardiographic or hemodynamic signs of cardiac tamponade. The prevalence and time course of pericardial effusion among patients with acute myocardial infarction who received rt-PA in this study are similar to observations reported in earlier studies in which patients did not receive thrombolytic therapy. Adverse sequelae of pericardial effusion after thrombolytic therapy are rare.