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Patients with immune checkpoint inhibitor (ICI)-associated pericarditis and myocarditis have significantly higher 1-year mortality rates compared to non-ICI cases, with rates of 44.3% and 38.9%, respectively. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 16, 2026Journal of the American Heart Association1 citationsOpen Access

Short‐ and Long‐Term Outcomes of Pericarditis, Myocarditis, and Myopericarditis in Patients With Malignancy on Immune Checkpoint Inhibitors

AAAnkit AgrawalCleveland Clinic ARAkiva RosenzveigInterventional Cardiology ASAhmad SafdarCleveland Clinic

Key Result

Patients with ICI-associated pericarditis had 1-year mortality of 44.3% and myocarditis had 38.9%, both higher than non-ICI cases (all P ≤0.002).

Key Points

To investigate the short- and long-term outcomes of ICI-associated pericarditis, myocarditis, and myopericarditis compared to non-ICI cases.
Retrospective analysis using the TriNetX database.
Involved patients over 18 receiving ICI and diagnosed with specified conditions within one year of therapy initiation.
Outcomes measured included all-cause mortality and need for additional interventions at 90-day, 1-year, and 5-year follow-ups.
1-year mortality rates for pericarditis, myocarditis, and myopericarditis were significantly higher in ICI patients compared to non-ICI counterparts.
Cox model indicated increased mortality hazards for all three conditions associated with ICI treatment, with the highest being myopericarditis.
All significance levels (P < 0.002 and P < 0.001 for various comparisons) suggest strong associations.

Structured PICO

Does immune checkpoint inhibitor therapy increase the risk of mortality and adverse cardiac outcomes in cancer patients who develop pericarditis, myocarditis, or myopericarditis compared to non-ICI treated patients?

Population

Adults >18 years old with a documented malignancy diagnosis who developed pericarditis, myocarditis, or myopericarditis. The propensity-matched cohorts included 3,661 patients with pericarditis, 226 with myocarditis, and 46 with myopericarditis in both the ICI and non-ICI groups.

Intervention

Immune checkpoint inhibitors (ICIs) including anti-PD-1 (nivolumab, cemiplimab, dostarlimab, pembrolizumab), anti-PD-L1 (atezolizumab, avelumab, durvalumab), or anti-CTLA-4 (ipilimumab) antibodies, initiated within 1 year prior to the index cardiac event.

Comparator

Non-ICI cases (patients with a documented malignancy and pericarditis, myocarditis, or myopericarditis but no record of ICI administration), propensity score matched on 50 characteristics.

Outcome

All-cause mortality, cardiac tamponade, constrictive pericarditis, need for pericardiocentesis, and pericardial window procedures evaluated at 90-day, 1-year, and 5-year follow-up.hard clinical

ICI-associated pericardial and myocardial inflammatory diseases carry a significantly higher risk of short- and long-term mortality compared to similar non-ICI cases, highlighting the need for high clinical suspicion and tailored monitoring.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but carry a risk of immune‐related adverse events, reported in 15% to 90% of the patients. ICI‐associated pericardial and myocardial disease has been increasingly recognized, yet data on outcomes remain limited. We aimed to use a large real‐world database to investigate the short‐ and long‐term outcomes of ICI‐associated pericarditis, myocarditis, and myopericarditis versus the non‐ICI cases. Methods We conducted a retrospective analysis using the TriNetX database to identify patients >18 years old on ICI and diagnosed with pericarditis, myocarditis, or myopericarditis within 1 year of initiation of therapy. The primary outcome assessed was all‐cause mortality, tamponade, constrictive pericarditis, and need for pericardiocentesis at 90‐day, 1‐year, and 5‐year follow‐up. Results A total of 3661, 226, and 46 patients were identified in matched cohorts of ICI‐induced pericarditis, myocarditis, and myopericarditis, respectively. One‐ and 5‐year mortality was greater for pericarditis (44.3% versus 37.3%; 54.3% versus 46.9%), myocarditis (38.9% versus 20.8%; 47.8% versus 34.3%), and myopericarditis (56.5% versus 28.3%; 63.0% versus 28.3%; all P ≤0.002). A multivariable Cox model showed increased ICI‐related mortality for pericarditis 1‐year hazard ratio HR, 1.20 (95% CI, 1.12–1.29), 5‐year HR, 1.26 (95% CI, 1.18–1.35), myocarditis 90‐day HR, 1.82 (95% CI, 1.21–2.73), 1‐year HR, 2.04 (95% CI, 1.43–2.91), 5‐year HR, 1.64 (95% CI, 1.26–2.61), and myopericarditis 1‐year HR, 2.24 (95% CI, 1.15–4.37), and 5‐year HR, 2.78 (95% CI, 1.44–5.36), all with P <0.001. Conclusion Among 3661, 226, and 46 patients with ICI‐associated pericarditis, myocarditis, and myopericarditis, respectively, we demonstrated an increased risk of all‐cause mortality as compared with the respective non‐ICI population.

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