Association Between Myocarditis and Mortality in Covid-19 Patients in a Large Registry

Annie, Frank; Embrey, Sarah; Alkhaimy, Haytham; Elashery, Ahmad Ramy; Nanjundappa, Aravinda

doi:10.1016/s0735-1097(21)04392-8

Cited by 8 publications

(5 citation statements)

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“…The prevalence of COVID-19-related myocarditis was between 0.1% to 0.4% in prior literature, which was similar to our prevalence data of 0.4% [6][7][8]. To our knowledge, our study is the largest study comparing outcomes in hospitalized patients with COVID-19 infection with and without myocarditis.…”

Section: Discussionsupporting

confidence: 88%

“…COVID-19-related myocarditis mortality is likely due to the burden of the inflammatory disease, independent of cardiovascular risk factors [27]. However, other studies suggest the opposite in that even the presence of one comorbidity increased the risk of mortality [6][7][8]28]. Prospective studies would be beneficial for clarification.…”

Section: Discussionmentioning

confidence: 99%

“…Myocarditis association with COVID-19 infection is well established by multiple studies [6][7][8]. Myocarditis refers to inflammation of cardiac muscles caused by infectious and non-infectious etiologies [9][10][11]) with viral etiologies being most common in the United States and other developed countries [11].…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample

Davis

Bobba

Chourasia

et al. 2022

Viruses

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Coronavirus-19 (COVID-19), preliminarily a respiratory virus, can affect multiple organs, including the heart. Myocarditis is a well-known complication among COVID-19 infections, with limited large-scale studies evaluating outcomes associated with COVID-19-related Myocarditis. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without Myocarditis. A total of 1,659,040 patients were included in the study: COVID-19 with Myocarditis (n = 6455, 0.4%) and COVID-19 without Myocarditis (n = 1,652,585, 99.6%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, sudden cardiac arrest, cardiogenic shock, acute kidney injury requiring hemodialysis, length of stay, health care utilization costs, and disposition. We conducted a secondary analysis with propensity matching to confirm results obtained by traditional multivariate analysis. COVID-19 patients with Myocarditis had significantly higher in-hospital mortality compared to COVID-19 patients without Myocarditis (30.5% vs. 13.1%, adjusted OR: 3 [95% CI 2.1–4.2], p < 0.001). This cohort also had significantly increased cardiogenic shock, acute kidney injury requiring hemodialysis, sudden cardiac death, required more mechanical ventilation and vasopressor support and higher hospitalization cost. Vaccination and more research for treatment strategies will be critical for reducing worse outcomes in patients with COVID-19-related Myocarditis.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample

Davis

Bobba

Chourasia

et al. 2022

Viruses

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“…For example, a retrospective analysis of a large registry database showed that 30-day all-cause mortality was significantly higher among those with myocarditis (13.4% vs 4.2%, p <0.001). 18 Similarly, fulminant myocarditis was associated with greater mortality rates among patients with COVID-19. 19−21 It has been hypothesized that inflammatory cytokine storm and direct action on myocytes through suppression of protein synthesis could be responsible for myocardial injury.…”

Section: Discussionmentioning

confidence: 95%

Hospital Outcomes Among COVID-19 Hospitalizations With Myocarditis from the California State Inpatient Database

Rubens

Ramamoorthy

Saxena

et al. 2022

The American Journal of Cardiology

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“…13 One recent study showed the prevalence of clinically confirmed COVID-19 myocarditis across a large multinational registry to be 0.01% (256 patients), with an associated increased mortality, underscoring the importance of diagnosing patients with myocarditis early in the process. 21 Current patient management is mainly supportive with the potential addition of interventions recommended for severe COVID-19 disease, such as remdesivir, dexamethasone with or without convalescent plasma. 22 In the setting of cardiogenic shock and refractory life-threatening arrhythmias, advanced mechanical circulatory support procedures should be considered.…”

Section: Covid-19 Induced Myocarditismentioning

confidence: 99%

Acute myocarditis caused by COVID-19 disease and following COVID-19 vaccination

Kornowski

Witberg

2022

Open Heart

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Myocarditis and pericarditis are inflammatory conditions of the heart that present a range of symptoms, often including chest pain, fatigue, breathlessness and palpitations that may be irregular due to cardiac rhythm disturbances. Myocarditis has been proposed to account for a fraction of cardiac injury among patients infected with SARS-CoV-2 and associated systemic inflammation; and it might be one of the reasons for the high mortality seen in COVID-19 patients. Furthermore, following vaccination with mRNA COVID-19 vaccines (ie, Comirnaty and Spikevax), myocarditis and pericarditis can develop within a few days of vaccination, particularly following the second dose. Based on recent reviewed data, the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have determined that the risk for both of these conditions is overall ‘very rare’ (~1 in 10 000 vaccinated people may be clinically affected), with the highest risk among younger males. Both EMA and FDA agree that the benefits of all authorised COVID-19 vaccines continue to outweigh their risks, given the threat of serious COVID-19 illness and related complications. Since myocarditis has a very wide clinical spectrum, ranging from mild to fulminant life-threatening disease, we present in this review a sum of the latest findings and considerations for the proper diagnosis and management of affected patients.

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Association Between Myocarditis and Mortality in Covid-19 Patients in a Large Registry

Cited by 8 publications

References 0 publications

COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample

COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample

Hospital Outcomes Among COVID-19 Hospitalizations With Myocarditis from the California State Inpatient Database

Acute myocarditis caused by COVID-19 disease and following COVID-19 vaccination

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