Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/27, LT-03101 Vilnius, Lithuania.
Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Santariškių 2, LT-08661 Vilnius, Lithuania.
Medicina (Kaunas). 2021 May 13;57(5):490. doi: 10.3390/medicina57050490.
Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI.
A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset.
Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.
经皮冠状动脉介入治疗（PCI）已知是心包炎的一种非常罕见的可能诱因。大多数情况下，它在潜伏期后或在围手术期并发症早期发生。在本报告中，我们介绍了一例在无并发症 PCI 后发生的非典型早发性心包炎。
一名 58 岁男性因左前降支（LAD）慢性完全闭塞而行 PCI 入院。初始心电图（ECG）无明显异常。PCI 尝试不成功。PCI 尝试结束时未观察到与程序相关的并发症，且患者无症状。PCI 后 6 小时，患者诉严重胸痛。ECG 显示前壁和侧壁导联的 ST 段抬高。肌钙蛋白 I 轻度升高，但冠状动脉造影未显示 LAD 区域侧支循环血流受损。由于心包炎胸痛、典型 ECG 表现和心包积液伴 C 反应蛋白升高，诊断为急性心包炎，并开始使用非甾体抗炎药（NSAIDs）治疗。胸痛缓解，ST 段抬高在治疗 3 天后几乎完全恢复基线。患者在症状出现后第 4 天稳定出院，无胸痛。
急性心包炎是 PCI 的罕见并发症。尽管缺乏特异性临床表现，但对于有心包炎症状和体征以及医源性损伤或胸部创伤史的患者，应考虑创伤后心包炎。
