Cardiac tamponade in the "new device" era: Evaluation of 6999 consecutive percutaneous coronary interventions

Background The incidence of cardiac perforation and pericardial tamponade a ppears to be increasing in the era of new coronary interventional devices c ompared with coronary balloon angioplasty. Methods and Results We reviewed 6999 consecutive percutaneous coronary inte rventions performed during 1994 to 1996 in a single urban university hospit al catheterization laboratory. Data had been collected prospectively as par t of an ongoing quality assurance program. Fifteen patients had cardiac tam ponade within 36 hours of the procedure. Only 6 of these occurred during th e interventional procedure; the others occurred 2 to 36 hours later. The me dian patient age was 72 years. Nine (60%) patients were female. Three patie nts received abciximab. Five perforations were at the target coronary arter y site, 3 were caused by a guide wire tip in the distal part of the target artery, and 7 represented right ventricular perforations caused by a tempor ary pacemaker wire. Five of the 7 right ventricular perforations occurred d uring rotational atherectomy procedures. Diagnosis was aided by immediate e chocardiography. Treatment was medical, including pericardiocentesis, in 6 cases. The other 9 patients required surgical drainage and repair. All pati ents survived the index hospitalization. At 18-month follow-up, 1 patient h ad died, and all others were without apparent sequelae. Conclusions Tamponade after percutaneous coronary intervention is not rare in the "new device" era (overall incidence 0.2%); tamponade after percutane ous coronary intervention is often delayed and may occur outside the cathet erization suite; patients are more likely to be female and elderly; immedia te echocardiography is an essential aid to diagnosis and prompt treatment, and the use of temporary right ventricular pacing catheters must be reexami ned.