Elsevier

The American Journal of Cardiology

Volume 160, 1 December 2021, Pages 112-116
The American Journal of Cardiology

Pericarditis Recurrence After Initial Uncomplicated Clinical Course

https://doi.org/10.1016/j.amjcard.2021.08.048Get rights and content

Acute pericarditis is an inflammatory disease associated with a non-negligible risk of acute complications and future recurrence. However, the exact incidence of pericarditis recurrence in patients with a first uncomplicated clinical course is unknown. We sought to evaluate the incidence and clinical predictors of recurrence after a first episode of acute uncomplicated pericarditis in a large urban hospital in the United States. We conducted a retrospective review, through electronic health records, to complete a database that includes patients admitted with a first episode of acute pericarditis and selected only those with an uncomplicated course (without in-hospital death, large pericardial effusion [>20 mm] or tamponade, constriction, or incessant pericarditis) at the VCU Medical Center (Richmond, Virginia) from 2009 to 2018. A total of 240 patients met acute pericarditis criteria: of the 240 patients, 164 patients (68%) had an uncomplicated course (median age [interquartile range] in years: 50 [32 to 62], 43% females). The median follow-up time was 186 (19 to 467) days. Pericarditis was idiopathic in 84 patients (51%). Fifteen patients (9%) had at least 1 episode of recurrent pericarditis. Compared with those without recurrence, patients with recurrent pericarditis were younger (37 [25 to 59] vs 51 [34 to 62] years, p = 0.034), had a higher prevalence of subacute/delayed presentation (2 [13%] vs 1 [1%], p = 0.023), and less frequently received colchicine (6 [40%] vs 100 [67%], p = 0.036). At multivariate logistic regression analysis, subacute presentation and younger age remained predictors of recurrence at follow-up. In conclusion, 9% of patients with acute pericarditis experienced a recurrence over a 6-month median follow-up despite an initial uncomplicated course. Younger age and subacute presentation were associated with a significantly increased risk of recurrence.

Section snippets

Methods

We conducted a retrospective review through an informatics engine–based search of electronic health records to create a database that includes patients admitted with a first episode of acute pericarditis at the Virginia Commonwealth University Medical Center (Richmond, Virginia) from 2009 to 2018. The method of the search has been previously described in detail.6 According to the last European Society of Cardiology guidelines, the diagnosis of acute pericarditis requires at least 2 of the 4

Results

A total of 240 patients met acute pericarditis criteria. Among them, 164 patients (68%) had an uncomplicated course, and 76 patients (32%) had an acute complicated clinical course. In patients with an uncomplicated clinical course, the median age was 50 (interquartile range 32 to 62) years, 43% were women, and 48% were Black. Pericarditis was considered idiopathic in 84 patients (51%), and 58 patients (35%) had post–cardiac surgery injury pericarditis. All patients were free of symptoms at

Discussion

We herein report the outcomes of patients hospitalized for a first uncomplicated episode of acute pericarditis in a large urban hospital in the United States: 9% of patients experienced a pericarditis recurrence in the following 6 months, with subacute presentation and younger age being independent predictors. Subacute presentation was defined as symptoms occurring over several days without a clear-cut acute onset. Patients with subacute presentation had already been reported to be at higher

Disclosures

Dr. Abbate has served as a consultant for AstraZeneca, Effetti, Implicit Biosciences, Kiniksa, Janssen, Merck, Novartis, Olatec, and Serpin Pharma. Dr. Vecchié received a travel grant from Kiniksa Pharmaceuticals Ltd. to attend the 2019 American Heart Association Scientific Sessions. Dr. Bonaventura received a travel grant from Kiniksa Pharmaceuticals Ltd. to attend the 2019 American Heart Association Scientific Sessions. The other authors have no conflicts of interest to disclose.

References (15)

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Drs. Del Buono and Vecchié contributed equally to this work.

This study was supported in part by a grant from Kiniksa Pharmaceuticals Ltd. to Dr. Gal and Dr. Abbate, and by the Bio-informatics Core of the institutional CTSA Award No. UL1TR002649 from the National Center for Advancing Translational Sciences (to Dr. Gal). Dr. Abbate received support from the Sapienza Visiting Professor Programme 2020 of the Sapienza Università di Roma, Italy. Research funding for this work was also generously provided by Drs. Claudia and Richard Balderston.

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