Original Investigation
Effect of Anti-Inflammatory Drugs on Clinical Outcomes in Patients With Malignant Pericardial Effusion

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Abstract

Background

Pericardiocentesis (PCC) with extended catheter drainage has become a relatively safe procedure to control pericardial effusion (PE), but little is known about long-term outcomes after PCC in malignant PE.

Objectives

This study evaluated the effects of anti-inflammatory agents on long-term outcomes after effective drainage of PE in active cancer patients.

Methods

From May 2007 to December 2018, 445 patients with malignant PE who underwent echocardiography-guided PCC were enrolled. Clinical, laboratory, echocardiographic and procedural findings, and clinical outcome data were collected. Use of anti-inflammatory agents including colchicine, nonsteroidal anti-inflammatory drugs, or steroids after PCC was also analyzed. Colchicine was administered in a dose of 0.6 mg orally, twice a day for 2 months. The primary outcome was defined as a composite of all-cause death and re-PCC or pericardial window operation due to recurred PE.

Results

The procedure was successful in 97.0% of the cases, with 1 procedure-related death. During the follow-up of 2 years, 26.1% of patients developed recurrent PE, and 46.0% developed constrictive pericarditis. The colchicine treatment group showed a significantly lower risk of composite events (adjusted hazard ratio [aHR]: 0.65; 95% confidence interval [CI]: 0.49 to 0.87; p = 0.003) as well as all-cause death (aHR: 0.60; 95% CI: 0.45 to 0.81; p = 0.001) than did the noncolchicine group. On propensity score matching, colchicine after PCC was consistently associated with a lower composite events (aHR: 0.55; 95% CI: 0.37 to 0.82; p = 0.003).

Conclusions

In cancer patients with malignant PE, PCC with extended drainage can be an appropriate therapeutic option and shows low complication rate. Patients receiving colchicine after successful PCC showed significant improvement in clinical outcome.

Key Words

cancer
colchicine
constrictive pericarditis
pericardial effusion
pericardiocentesis

Abbreviations and Acronyms

aHR
adjusted hazard ratio
CEA
carcinoembryonic antigen
CI
confidence interval
CP
constrictive pericarditis
HR
hazard ratio
IQR
interquartile range
IVC
inferior vena cava
LD
lactate dehydrogenase
NSAID
nonsteroidal anti-inflammatory drug
PCC
pericardiocentesis
PE
pericardial effusion

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The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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