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

Eur J Clin Invest. 2021 Nov;51(11):e13679. doi: 10.1111/eci.13679. Epub 2021 Sep 18.


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.

Keywords: COVID-19; MACE; cardiovascular sequelae; myocarditis; pericarditis.

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation / epidemiology*
  • COVID-19 / complications
  • COVID-19 / epidemiology*
  • Case-Control Studies
  • Cause of Death
  • Cohort Studies
  • Critical Care
  • Female
  • Heart Arrest / epidemiology*
  • Heart Failure / epidemiology*
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mortality*
  • Myocardial Infarction / epidemiology*
  • Myocarditis / complications
  • Myocarditis / epidemiology*
  • Pericarditis / complications
  • Pericarditis / epidemiology*
  • Propensity Score
  • Retrospective Studies
  • SARS-CoV-2
  • Severity of Illness Index
  • United States / epidemiology