New-onset myocarditis and pericarditis in COVID-19 patients were associated with increased 6-month all-cause mortality compared to matched controls (OR 1.36 and OR 2.55, respectively).
Cohort (n=718,365)
Yes
Does new-onset myocarditis or pericarditis increase the risk of adverse cardiovascular events and mortality in patients with COVID-19?
New-onset myocarditis and pericarditis in COVID-19 patients are associated with significantly increased odds of 6-month mortality and major adverse cardiovascular events.
Odds Ratio: 1.36 (95% CI 1.21–1.53)
Absolute Event Rate: 3.9% vs 2.9%
p-value: p=<.0001
BACKGROUND: COVID-19 has a wide spectrum of cardiovascular sequelae including myocarditis and pericarditis; however, the prevalence and clinical impact are unclear. We investigated the prevalence of new-onset myocarditis/pericarditis and associated adverse cardiovascular events in patients with COVID-19. METHODS AND RESULTS: A retrospective cohort study was conducted using electronic medical records from a global federated health research network. Patients were included based on a diagnosis of COVID-19 and new-onset myocarditis or pericarditis. Patients with COVID-19 and myocarditis/pericarditis were 1:1 propensity score matched for age, sex, race and comorbidities to patients with COVID-19 but without myocarditis/pericarditis. The outcomes of interest were 6-month all-cause mortality, hospitalisation, cardiac arrest, incident heart failure, incident atrial fibrillation and acute myocardial infarction, comparing patients with and without myocarditis/pericarditis. Of 718,365 patients with COVID-19, 35,820 (5.0%) developed new-onset myocarditis and 10,706 (1.5%) developed new-onset pericarditis. Six-month all-cause mortality was 3.9% (n = 702) in patients with myocarditis and 2.9% (n = 523) in matched controls (p < .0001), odds ratio 1.36 (95% confidence interval (CI): 1.21-1.53). Six-month all-cause mortality was 15.5% (n = 816) for pericarditis and 6.7% (n = 356) in matched controls (p < .0001), odds ratio 2.55 (95% CI: 2.24-2.91). Receiving critical care was associated with significantly higher odds of mortality for patients with myocarditis and pericarditis. Patients with pericarditis seemed to associate with more new-onset cardiovascular sequelae than those with myocarditis. This finding was consistent when looking at pre-COVID-19 data with pneumonia patients. CONCLUSIONS: Patients with COVID-19 who present with myocarditis/pericarditis associate with increased odds of major adverse events and new-onset cardiovascular sequelae.
Buckley et al. (2021) conducted a cohort in COVID-19 (n=718,365). New-onset myocarditis or pericarditis vs. Propensity score matched patients with COVID-19 without myocarditis/pericarditis was evaluated on 6-month all-cause mortality (OR 1.36, 95% CI 1.21-1.53, p=<.0001). New-onset myocarditis and pericarditis in COVID-19 patients were associated with increased 6-month all-cause mortality compared to matched controls (OR 1.36 and OR 2.55, respectively).