Prevalence and clinical outcomes of myocarditis and pericarditis in 718,365 COVID‐19 patients

Buckley, Benjamin J R; Harrison, Stephanie L; Fazio‐Eynullayeva, Elnara; Underhill, Paula; Lane, Deirdre A.; Lip, Gregory Y.H.

doi:10.1111/eci.13679

Cited by 76 publications

(69 citation statements)

References 30 publications

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“…The authors concluded that given the extremely low frequency of myocarditis and the unclear therapeutic implications, the use of endomyocardial biopsy to diagnose myocarditis in the setting of COVID-19 is not recommended. A recent series (22), where 5% of the patients developed new onset myocarditis, confirms these results.…”

Section: Discussionsupporting

confidence: 57%

Late Cardiac Pathology in Severe Covid-19. A Postmortem Series of 30 Patients

Ferrer-Gómez

Pian-Arias

Carretero‐Barrio

et al. 2021

Front. Cardiovasc. Med.

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The role of SARS-CoV-2 as a direct cause in the cardiac lesions in patients with severe COVID-19 remains to be established. Our objective is to report the pathological findings in cardiac samples of 30 patients who died after a prolonged hospital stay due to Sars-Cov-2 infection. We performed macroscopic, histological and immunohistochemical analysis of the hearts of 30 patients; and detected Sars-Cov-2 RNA by RT-PCR in the cardiac tissue samples. The median age of our cohort was 69.5 years and 76.6% were male. The median time between symptoms onset and death was 36.5 days. The main comorbidities were arterial hypertension (13 patients, 43.3%), dyslipidemia (11 patients, 36.7%), cardiovascular conditions (8 patients, 26.7%), and obesity (8 patients, 26.7%). Cardiovascular conditions included ischemic cardiopathy in 4 patients (13.3%), hypertrophic cardiomyopathy in 2 patients (6.7%) and valve replacement and chronic heart failure in one patient each (3.3%). At autopsy, the most frequent histopathological findings were coronary artery atherosclerosis (8 patients, 26.7%), left ventricular hypertrophy (4 patients, 13.3%), chronic epicardial inflammation (3 patients, 10%) and adipose metaplasia (2 patients, 6.7%). Two patients showed focal myocarditis, one due to invasive aspergillosis. One additional patient showed senile amyloidosis. Sars-Cov-2 RNA was detected in the heart of only one out of 30 patients, who had the shortest disease evolution of the series (9 days). However, no relevant cardiac histological alterations were identified. In present series, cardiac pathology was only modest in most patients with severe COVID-19. At present, the contribution of a direct effect of SARS-CoV-2 on cardiac lesions remains to be established.

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Section: Discussionsupporting

confidence: 57%

Late Cardiac Pathology in Severe Covid-19. A Postmortem Series of 30 Patients

Ferrer-Gómez

Pian-Arias

Carretero‐Barrio

et al. 2021

Front. Cardiovasc. Med.

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“…At the time of writing, Australian data on myocarditis in COVID-19 patients were limited (Table 1). Model assumptions on the incidence and CFR of myocarditis in COVID-19 patients were obtained from an international cohort study by Buckley et al [34], and additional unpublished age-sex specific data from the study via personal communication with the lead author. Data showed incidence ranging from 1.66% to 13.74%, and CFR ranging from <1% to 15.14%, depending on age and sex (Supplementary Table S8).…”

Section: Resultsmentioning

confidence: 99%

“…The definitions for vaccine-associated and infection-induced myocarditis used for the model reflect those used within the studies from which data were drawn. Vaccine-associated myocarditis was defined as confirmed myocarditis within approximately 10 days of vaccine administration [31], and COVID-19-related myocarditis was defined as myocarditis that occurred within 6 months of COVID-19 diagnosis [34].…”

Section: Myocarditismentioning

confidence: 99%

“…We thank Kim Sampson from Immunisation Coalition and Dr Andrew Baird (St Kilda Medical Group, Australia) for facilitating the collaboration between authors; Aapeli Vuorinen (Data Science Institute, Columbia University, USA) for programming the online CoRiCal tool; Dr Michael Waller (School of Public Health, The University of Queensland, Australia) for contributions to model validation; A/Prof Hassan Valley (Deakin University, Melbourne, Australia) for contributions to discussions about risk communication and data visualisation; A/Prof Sudhir Wahi, Director of Echocardiography and Senior Staff Cardiologist, Cardiac Society of Australia and New Zealand (CSANZ) Imaging Council for their feedback on myocarditis-related data; and Dr Benjamin J.R. Buckley (University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK) for providing data on age and sex subgrouping of COVID-19-related myocarditis cases and deaths of the cohort described in [34]. Our BN model was built using GeNIe Modeler (BayesFusion 2019), available free of charge for academic research and teaching use from https://www.bayesfusion.com.…”

Section: Acknowledgmentsmentioning

confidence: 99%

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Quantifying the risks versus benefits of the Pfizer COVID-19 vaccine in Australia: a Bayesian network analysis

Sinclair

Mayfield

Short

et al. 2022

Preprint

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The Pfizer COVID-19 vaccine is associated with increased myocarditis incidence. Constantly evolving evidence regarding incidence and case fatality of COVID-19 and myocarditis related to infection or vaccination, creates challenge for risk-benefit analysis of vaccination programs. Challenges are complicated further by emerging evidence of waning vaccine effectiveness, and variable effectiveness against variants. Here, we build on previous work on the COVID-19 Risk Calculator (CoRiCal) by integrating Australian and international data to inform a Bayesian network that calculates probabilities of outcomes for the Delta variant under different scenarios of Pfizer COVID-19 vaccine coverage, age groups (≤12 years), sex, community transmission intensity and vaccine effectiveness. The model estimates that in a population where 5% were unvaccinated, 5% had one dose, 60% had two doses and 30% had three doses, the probabilities of developing and dying from COVID-19-related myocarditis were 239-5847 and 1430-384,684 times higher (depending on age and sex), respectively, than developing vaccine-associated myocarditis. For one million people with this vaccine coverage, where transmission intensity was equivalent to 10% chance of infection over two months, 68,813 symptomatic COVID-19 cases and 981 deaths would be prevented, with 42 and 16 expected cases of vaccine-associated myocarditis in males and females, respectively. The model may be updated to include emerging best evidence, data pertinent to different countries or vaccines, and other outcomes such as long COVID.

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“…Previously, among 718,365 patients with COVID-19, approximately 6.5% developed new-onset myopericarditis. 5 This higher rate might be an overestimate since most of the patients presented with mild COVID-19 symptoms may not get admitted and diagnosed, thus, not registered with the electronic medical records. Furthermore, our cases represented population-based data locally in Hong Kong, which has practised meticulous contact tracing since the pandemic; the number of total COVID-19 patients in our cohort would, therefore, likely reflect most of the infected patients in the community.…”

Section: Discussionmentioning

confidence: 99%

Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study

Chou

Zhou

Lee

et al. 2021

Preprint

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Background: Both COVID-19 infection and COVID-19 vaccines have been associated with the development of myopericarditis. The objective of this study is to 1) analyze the rates of myopericarditis after COVID-19 infection and COVID-19 vaccination in Hong Kong and 2) compare to the background rates, and 3) compare the rates of myopericarditis after COVID-19 vaccination to those reported in other countries. Methods: This was a population-based cohort study from Hong Kong, China. Patients with positive RT-PCR test for COVID-19 between 1st January 2020 and 30th June 2021 or individuals who received COVID-19 vaccination until 31st August were included. The main exposures were COVID-19 positivity or COVID-19 vaccination. The primary outcome was myopericarditis. Results: This study included 11441 COVID-19 patients from Hong Kong, of whom four suffered from myopericarditis (rate per million: 350; 95% confidence interval [CI]: 140-900). The rate was higher than the pre-COVID-19 background rate in 2020 (rate per million: 61, 95% CI: 55-67) with a rate ratio of 5.73 (95% CI: 2.23-14.73. Compared to background rates, the rate of myopericarditis among vaccinated subjects in Hong Kong was substantially lower (rate per million: 8.6; 95% CI: 6.4-11.6) with a rate ratio of 0.14 (95% CI: 0.10-0.19). The rates of myocarditis after vaccination in Hong Kong are comparable to those vaccinated in the United States, Israel, and the United Kingdom. Conclusions: COVID-19 infection is associated with a higher rate of myopericarditis whereas COVID-19 vaccination is associated with a lower rate of myopericarditis compared to the background.

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Prevalence and clinical outcomes of myocarditis and pericarditis in 718,365 COVID‐19 patients

Cited by 76 publications

References 30 publications

Late Cardiac Pathology in Severe Covid-19. A Postmortem Series of 30 Patients

Late Cardiac Pathology in Severe Covid-19. A Postmortem Series of 30 Patients

Quantifying the risks versus benefits of the Pfizer COVID-19 vaccine in Australia: a Bayesian network analysis

Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study

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