Key result
COVID-19 was associated with a higher incidence of acute (myo)pericarditis compared to non-COVID patients (OR 4.43; 95% CI 3.98-4.94) and higher in-hospital mortality (OR 7.75; 95% CI 2.77-21.7).
Why the study?
The incidence, risk factors, clinical characteristics, and outcomes of acute (myo)pericarditis in patients with COVID-19 were not well established.
Does COVID-19 infection increase the incidence and severity of acute (myo)pericarditis compared to non-COVID populations?
Case-Control
Yes
Does COVID-19 infection increase the incidence and severity of acute (myo)pericarditis compared to non-COVID populations?
Acute (myo)pericarditis in COVID-19 patients is rare but presents atypically with greater severity, more ventricular dysfunction, and significantly higher in-hospital mortality compared to non-COVID-19 cases.
COVID-19 AMP linked to atypical features and higher mortality; leaves open whether targeted screening or therapy alters outcomes.
OBJECTIVE: To estimate incidence, risk factors, clinical characteristics and outcomes of acute (myo)pericarditis (AMP) in patients with COVID-19. METHODS: Case-control, retrospective review, consecutive case inclusion performed in 62 Spanish EDs. All COVID-19 patients with AMP (cases) were compared in clinical characteristics and outcomes with COVID-19 without AMP (control group A) and non-COVID patients with AMP (control group B). We estimated unadjusted standardised incidence (SI, not adjusted by population's age/sex) of AMP in COVID-19 and non-COVID populations (per 100 000/year). RESULTS: We identified 67 AMP in COVID-19 patients (SI=56.5, OR with respect to non-COVID patients=4.43, 95% CI=3.98 to 4.94). Remarkably, COVID-19 cases presented with chest pain less frequently than non-COVID patients and had less typical ECG changes, higher NT-proBNP (N-terminal prohormone of brain natriuretic peptide), more left and right ventricular dysfunction in echocardiography and more need of inotropic/vasopressor drugs. Admission to intensive care was higher than control group A (OR=3.22, 95% CI=1.43 to 7.23), and in-hospital mortality was higher than control group B (OR=7.75, 95% CI=2.77 to 21.7). CONCLUSION: AMP is unusual as a form of COVID-19 presentation (about 1‰ cases), but SI is more than fourfold higher than non-COVID population, and it is less symptomatic, more severe and has higher in-hospital mortality; therefore, rapid recognition, echocardiographic assessment of myopericardial inflammation/dysfunction and treatment with vasoactive drugs when needed are recommended in AMP in patients with COVID-19.
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Miró et al. (2022) conducted a case-control in COVID-19 and acute (myo)pericarditis. COVID-19 vs. Non-COVID patients was evaluated on Incidence of acute (myo)pericarditis (OR 4.43, 95% CI 3.98 to 4.94). COVID-19 was associated with a higher incidence of acute (myo)pericarditis compared to non-COVID patients (OR 4.43; 95% CI 3.98-4.94) and higher in-hospital mortality (OR 7.75; 95% CI 2.77-21.7).
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