COMPARISON OF FREQUENCY, DIAGNOSTIC AND PROGNOSTIC-SIGNIFICANCE OF PERICARDIAL INVOLVEMENT IN ACUTE MYOCARDIAL-INFARCTION TREATED WITH AND WITHOUT THROMBOLYTICS

Data from the Gruppo Italiano per lo Studio della Sopravvivenza nell'I nfarto Miocardico (GISSI) trial were reviewed to describe the epidemio logy of pericardial involvement in patients treated with or without th rombolysis, and to establish its role as a marker of the extent of myo cardial infarction and its prognostic value. In both GISSI-1 (r = 11,8 06) and 2 (n = 12,381), a specific item regarding presence/absence of clinically detected pericardial involvement was included in the study forms. In GISSI-1, patients with ST elevation and depression at the on set of myocardial infarction were admitted, whereas GISSI-2 included o nly those with ST elevation. Results of univarate analysis are present ed as Mantel-Haenszel-Peto odds ratios with 95% confidence intervals C ox proportional hazards models were used to assess the independent pro gnostic significance of pericardial involvement for in-hospital and lo ng-term mortality. The main results indicate that: (1) the incidence o f pericardial involvement in patients treated with thrombolytic agents is approximately half of that in the control group (6.7 vs 12.0%); (2 ) the earlier is the treatment, the lower is the incidence of pericard ial involvement; (3) pericardial involvement is strongly associated wi th infarction size, evaluated by electrocardiograms, creatine kinase p eak and echo assessments; and (4) pericardial involvement is associate d with a higher long-term mortality, but is not an independent prognos tic factor (RR 1.02; 95% confidence interval 0.82-1.26). Pericardial i nvolvement is a reliable bedside, cost-free marker of myocardial infar ction size and poorer outcome. Because it may elude detection owing to its transitory and often short duration, it should be given greater a ttention.