Etiology and long-term outcomes of patients undergoing pericardiocentesis for malignant cardiac tamponade

Background Malignant cardiac tamponade represents a life-threatening manifestation of advanced malignancy. However, most available studies combine patients with malignant pericardial effusion with and without hemodynamic compromise, limiting insights specific to cardiac tamponade and its prognostic implications. Methods We conducted a retrospective observational study of consecutive patients who underwent therapeutic pericardiocentesis for malignant cardiac tamponade between 2012 and 2024 at a tertiary referral center. Clinical presentation, oncological status, imaging findings, procedural characteristics, cytological results, in-hospital complications, and long-term outcomes were analyzed. Survival was assessed using Kaplan–Meier analysis, while in-hospital, 30-day, and 1-year mortality were reported as crude proportions. Results Among 613 cases of non–cardiac surgery–related cardiac tamponade, 180 patients met the inclusion criteria. Dyspnea was the predominant presenting symptom (99.4%). Lung cancer was the most frequent underlying malignancy (53.9%), and metastatic disease was present in 78.8% of patients. In-hospital mortality was 12.8%. Cytological examination of pericardial fluid was positive for malignancy in 47.8% of cases. Recurrent cardiac tamponade occurred in 11.9% of patients, with a median time to recurrence of 50 days. Long-term outcomes were poor: overall mortality reached 88.2%, median survival was 146 days (95% CI 104–189), and one-year mortality was 80.9%. Conclusions Malignant cardiac tamponade is most often a late manifestation of advanced metastatic cancer and is associated with an extremely poor prognosis. Despite effective acute hemodynamic stabilization, long-term survival remains limited. Malignant cardiac tamponade should be regarded as a distinct, high-risk oncologic emergency requiring prompt interdisciplinary management and realistic prognostic assessment.