Long-term mortality and acute complications after percutaneous pericardiocentesis in cancer and noncancer patients presenting with severe pericardial effusion

AIMS: Percutaneous pericardiocentesis is the standard diagnostic and therapeutic procedure for severe pericardial effusion (PE). While its procedural safety has improved over time, data on long-term outcomes in cancer patients remain limited. We aim to evaluate clinical outcomes after pericardiocentesis, with a specific focus on neoplastic-related PE. METHODS: We collected data of patients who underwent percutaneous pericardiocentesis at the University Hospital of Modena, between December 2006 and September 2025. Patients were stratified into three groups: neoplastic, idiopathic, and other specific etiologies. The primary endpoint was all-cause mortality, while the secondary endpoint was a composite of in-hospital adverse events. RESULTS: A total of 179 patients were included (median age 72, 39.7% women). Major procedural-related complications occurred in 4.5% of patients, while in-hospital mortality was 15.6%. During a mean follow-up of 15.8 months, 44.1% of patients died. Mortality was significantly higher in patients with neoplastic PE (61.1%) compared with those with other etiologies (44.9%) and idiopathic PE (23.4%, p = 0.001). Neoplastic etiology was independently associated with an increased risk of death compared with idiopathic PE (aHR 5.22, 95% CI 2.41-11.35). CONCLUSIONS: Our study showed that percutaneous pericardiocentesis is an effective and safe procedure, with a major complication rate consistent with contemporary series across variable etiologies. Despite similar procedural safety, patients with neoplastic PE experienced markedly worse long-term outcomes linked to the underlying malignancy rather than the procedure itself. In oncological patients, pericardiocentesis should be contextualized within the overall oncological trajectory, balancing procedural benefit with patient prognosis and individual treatment goals.