Clinical profile, survival, and prognostic determinants in malignant cardiac tamponade requiring pericardiocentesis

Malignant cardiac tamponade is a life-threatening manifestation of advanced malignancy.Most studies combine patients with malignant pericardial effusion, limiting insights specificto cardiac tamponade.

This study aimed to characterize the clinical profile, outcomes, and predictors of mortality inpatients undergoing pericardiocentesis for malignant cardiac tamponade.

We performed a retrospective observational study of consecutive patients who underwent therapeutic pericardiocentesis for malignant cardiac tamponade between 2012 and 2024 ata tertiary referral center. Clinical characteristics and outcomes were assessed. Survival was estimatedusing Kaplan-Meier analysis, and predictors of mortality were evaluated using Cox proportionalhazards models.

Among 613 cases of cardiac tamponade unrelated to cardiac surgery, 180 patients metthe inclusion criteria. Dyspnea was the predominant symptom (99.4%). Lung cancer was the mostcommon malignancy (53.9%), and metastatic disease was present in 78.8% of the subjects. In-hospitalmortality was 12.8%, and 30-day mortality was 25.5%. Pericardial fluid cytology was positivein 47.8%. Recurrent tamponade occurred in 11.9% of patients, with a median time to recurrence of50 days. During follow-up, 88.7% of the subjects died. Median survival was 144.5 days (95% confidenceinterval, 28.3-477.9), and the estimated 1-year mortality was 66.5%. Lung cancer was associatedwith higher mortality in multivariable analysis (hazard ratio, 1.50; P = 0.017).

Malignant cardiac tamponade is a late manifestation of advanced cancer associated with markedly limited survival despite effective acute treatment and temporal changes in oncologicalcase mix. Lung cancer was associated with worse prognosis in multivariable analysis. Malignantcardiac tamponade represents a high-risk oncologic emergency requiring interdisciplinary care.