Clinically Significant Pericardial Effusion Requiring Drainage in Patients With Cancer

The incidence and prognostic implications of clinically significant pericardial effusion requiring drainage among patients with cancer remain incompletely characterized.

The authors aimed to investigate the incidence, cancer-specific risk, and prognostic implications of clinically significant pericardial effusion among patients with cancer.

We analyzed 2 population-based cohorts (Korean National Health Insurance Service and UK Biobank), comparing adults with incident cancer and age- and sex-matched noncancer controls. Among patients with cancer, drainage-date-anchored matched analyses evaluated subsequent mortality, new-onset atrial fibrillation (NOAF), and heart failure (HF) using Cox and Fine-Gray models, with landmark and restricted mean time analyses.

Over a median follow-up of 7.7 years (Q1-Q3: 6.3-9.2) in the Korean National Health Insurance Service and 5.2 years (1.8-8.2) in the UK Biobank, clinically significant pericardial effusion occurred in 1,088 of 499,127 patients with cancer vs 320 of 390,260 controls (33.66 [95% CI: 31.7-35.7] vs 10.32 [9.2-11.5] per 100,000 person-years). Risk was greatest for cancers anatomically adjacent to the heart. Pericardial effusion was associated with higher all-cause mortality (adjusted HR: 13.29; 95% CI: 12.21-14.46) and with increased risks of NOAF and HF. Excess mortality persisted among patients surviving beyond 30 days and beyond 1 year, whereas associations with nonfatal outcomes were attenuated after accounting for competing mortality.

Cancer was associated with a higher incidence of clinically significant pericardial effusion. Among patients with cancer, this phenotype identified a substantially higher risk of death and increased risks of NOAF and HF, and the excess risk was not explained by early periprocedural mortality alone.