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A case-control, multicentre study of consecutive patients with COVID-19 and acute (myo)pericarditis: incidence, risk factors, clinical characteristics and outcomes
  1. Òscar Mirò1,
  2. Manel Sabaté2,
  3. Sònia Jiménez1,
  4. Alexandre Mebazaa3,
  5. Gemma Martínez-Nadal1,
  6. Pascual Piñera4,
  7. Guillermo Burillo-Putze5,
  8. Alfonso Martín6,
  9. Francisco Javier Martín-Sánchez7,
  10. Javier Jacob8,
  11. Aitor Alquézar-Arbé9,
  12. Eric Jorge García-Lamberechts7,
  13. Pere Llorens10,
  14. Juan González del Castillo7
  15. on behalf of the Spanish Investigators on Emergency Situations TeAm (SIESTA) network
    1. 1Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
    2. 2Cardiology Department, Hospital Clínic, Barcelona, Spain
    3. 3Department of Anaesthesiology and Critical Care Medicine, Saint Louis and Lariboisière University Hospitals, Paris, France
    4. 4Emergency Department, Hospital Reina Sofia de Murcia, Murcia, Spain
    5. 5Emergency Department, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife, Spain
    6. 6Hospital Universitario Severo Ochoa, Leganes, Madrid, Spain
    7. 7Emergency, Hospital Clinico San Carlos, Madrid, Spain
    8. 8Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain
    9. 9Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
    10. 10Emergency Department, Hospital General Universitario de Alicante, Alicante, Spain
    1. Correspondence to Dr Òscar Mirò, Emergency Department, Hospital Clinic, 08036 Barcelona, Spain; omiro{at}clinic.cat

    Abstract

    Objective To estimate incidence, risk factors, clinical characteristics and outcomes of acute (myo)pericarditis (AMP) in patients with COVID-19.

    Methods Case-control, retrospective review, consecutive case inclusion performed in 62 Spanish EDs. All COVID-19 patients with AMP (cases) were compared in clinical characteristics and outcomes with COVID-19 without AMP (control group A) and non-COVID patients with AMP (control group B). We estimated unadjusted standardised incidence (SI, not adjusted by population’s age/sex) of AMP in COVID-19 and non-COVID populations (per 100 000/year).

    Results We identified 67 AMP in COVID-19 patients (SI=56.5, OR with respect to non-COVID patients=4.43, 95% CI=3.98 to 4.94). Remarkably, COVID-19 cases presented with chest pain less frequently than non-COVID patients and had less typical ECG changes, higher NT-proBNP (N-terminal prohormone of brain natriuretic peptide), more left and right ventricular dysfunction in echocardiography and more need of inotropic/vasopressor drugs. Admission to intensive care was higher than control group A (OR=3.22, 95% CI=1.43 to 7.23), and in-hospital mortality was higher than control group B (OR=7.75, 95% CI=2.77 to 21.7).

    Conclusion AMP is unusual as a form of COVID-19 presentation (about 1‰ cases), but SI is more than fourfold higher than non-COVID population, and it is less symptomatic, more severe and has higher in-hospital mortality; therefore, rapid recognition, echocardiographic assessment of myopericardial inflammation/dysfunction and treatment with vasoactive drugs when needed are recommended in AMP in patients with COVID-19.

    • COVID-19

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Data are available from the authors with the permission of respectively intitutions. The data that support the findings of this study are available from the corresponding author, (ÒM), on reasonable request.

    This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    https://bmj.com/coronavirus/usage

    https://doi.org/10.1136/emermed-2020-210977

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplementary information. Data are available from the authors with the permission of respectively intitutions. The data that support the findings of this study are available from the corresponding author, (ÒM), on reasonable request.

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      Footnotes

      • Handling editor David Metcalfe

      • Twitter @sonia_austen_70

      • Collaborators The SIESTA network is formed by the following researchers and centres (all from Spain): Steering Committee: Òscar Miró, Sònia Jiménez (Hospital Clínic, Barcelona), Juan González del Castillo, Francisco Javier Martín-Sánchez (Hospital Clínico San Carlos, Madrid), Pere Llorens (Hospital General de Alicante), Guillermo Burillo-Putze (Hospital Universitario de Canarias, Tenerife), Alfonso Martín (Hospital Universitario Severo Ochoa de Leganés, Madrid), Pascual Piñera Salmerón (Hospital General Universitario Reina Sofía, Murcia), E. Jorge García Lamberechts (Hospital Clínico San Carlos, Madrid), Javier Jacob (Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona), Aitor Alquézar-Arbé (Hospital de la Santa Creu i Sant Pau, Barcelona). Participating centres: (1) -Hospital Universitario Doctor Peset Aleixandre de Valencia: María Luisa López Grima, Mª Ángeles Juan Gómez. (2) Hospital Universitario y Politécnico La Fe de Valencia: Javier Millán, Leticia Serrano Lázaro. (3) Hospital Universitario General de Alicante: Tamara García, Ana Belen Paya. (4) Hospital Clínico Universitario de Valencia: José Noceda. (5) Hospital Arnau de Vilanova de Valencia: María José Cano Cano, Rosa Sorando Serra. (6) Hospital Francesc de Borja de Gandía, Valencia: María José Fortuny Bayarri, Francisco José Salvador Suárez. (7) Hospital General Universitario de Elche, Alicante: Matilde González Tejera. (8) Hospital Marina Baixa de Villajoyosa de Alicante: Juan Miguel Marín Porrino, Monica Valera Varea, Rosa María Hernández Sánchez. (9) Hospital Virgen de los Lirios, Alcoy Alicante: Napoleón Meléndez, Patricia Borrás Albero. (10) Hospital Universitario Vinalopó de Elche (Alicante): Blas Jiménez, Karen Josefina Angarita Manrique, Rafael Esteve Solano. (11) Hospital Universitario de Torrevieja de Alicante: Rigoberto del Río, Alexandra Milan Mestre, Fernando Lajara Navarro. (12) Hospital Lluis Alcanys de Xativa: Carles Pérez García, Pilar Sánchez Amador. (13) Hospital Universitario de La Ribera de Valencia: José Vicente Brasó Aznar, José Luis Ruiz López. (14) Hospital de la Vega Baja Orihuela de Alicante:María Carmen Ponce. (15) Hospital Universitario Sant Joan Alicante: Elena Díaz Fernández. (16) Hospital General de Requena de Valencia: Laura Ejarque Martinez, Carol Cuenca Valero. (17) Hospital de Lliria de Valencia: Ana Peiró Gómez, Elena Gonzalo Bellver. (18) Hospital de la Santa Creu i Sant Pau (Barcelona): Carla Cabrera Suarez, Laura Balcells Argilag. (19) Hospital Clinic (Barcelona): Carlos Cardozo. (20) Hospital Universitari de Bellvitge de Hospitalet de Llobregat (Barcelona): Ferran Llopis-Roca, Antonio Haro-Bosch. (21) Hospital Universitari Germans Trias i Pujol de Badalona (Barcelona): Josep Maria Mòdol Deltell, Samuel Olmos Soto. (22) Hospital de Terrassa (Barcelona): Josep Tost. (23) Hospital del Mar (Barcelona): Alfons Aguirre Tejedo, Silvia Minguez Masó. (24) Hospital Universitari Joan XXIII (Tarragona): Anna Palau, Ruth Gaya Tur. (25) Hospital Universitari de Girona Dr. Josep Trueta (Girona): Maria Adroher Muñoz, Ester Soy Ferrer. (26) Hospital Universitari de Vic (Barcelona): Lluís LLauger García. (27) Hospital de Sant Pau i Santa Tecla (Tarragona): Enrique Martín Mojarro, Brigitte Silvana Alarcón Jiménez, Silvia Flores Quesada. (28) Clinica Sagrada Familia (Barcelona): Arturo Huerta. (29) Hospital Clínico San Carlos (Madrid): Marcos Fragiel. (30) Hospital Universitario La Paz (Madrid): Alejandro Martín Quirós, Elena Muñoz del Val, Angelica Rivera Núñez. (31) Hospital Universitario de la Princesa (Madrid): Carmen del Arco Galán, Guillermo Fernández Jiménez. (32) Hospital Universitario Severo Ochoa de Leganés (Madrid): Irene Cabrera Rodrigo, Dolores Corbacho Loarte. (33) Hospital Universitario Rey Juan Carlos (Madrid): Verónica Prieto Cabezas, Mª José Venegas De L'Hotellerie. (34) Hospital Universitario del Henares (Madrid): Cristobal M. Rodriguez Leal, Patricia Fraga Rivas. (35) Hospital Universitario de Fuenlabrada (Madrid): Marta Álvarez Alonso, Cristina Latorre Marco. (36) Hospital Universitario Infanta Cristina de Parla (Madrid): Ruth Calderón Hernaiz, Mary Gaby Llaro Casas. (37) Hospital Comarcal El Escorial (Madrid): Silvia Ortiz Zamorano, Frida Vallejo Somohano. (38) Clínica Universidad Navarra de Madrid: Raquel Piñero Panadero, Nieves López-Laguna. (39) Hospital Universitario de Salamanca: Angel García García, Cristina Gil Castillo. (40) Complejo Asistencial Universitario de León: Marta González Calabaza, Begoña Carmona Ayuela. (41) Hospital Universitario de Burgos: María Pilar López Díez. (42) Hospital Universitario Rio Hortega (Valladolid): Irena Cebrián Ruiz, Lorena Delgado Alonso, Rocío Ruiz Merino. (43) Complejo Asistencial de Soria: Fahd Beddar Chaib,Ikram Samira Mohamedi Abdelkader. (44) Hospital Universitario Regional de Málaga: Manuel Salido, Iván Villar Mena. (45) Hospital Universitario Juan Ramón Jiménez: María Angeles Garrido López, Setefilla Borne Jerez. (46) Hospital Costa del Sol de Marbella: Carmen Agüera Urbano, Ana Belen García Soto. (47) Hospital Valle de los Pedroches de Pozoblanco (Córdoba): Jorge Pedraza García. (48) Hospital Virgen del Rocío de Sevilla: Amparo Fernández de Simón Almela. (49) Complejo Hospitalario Universitario de A Coruña: Ricardo Calvo López. (50) Hospital Universitario Lucus Augusti Lugo: Juan José López Díaz. (51) Complejo Hospitalario Universitario de Vigo. Hospital Álvaro Cunqueiro: María Teresa Maza Vera, Raquel Rodríguez Calveiro. (52) Hospital Universitario General de Albacete: Francisco Javier Lucas-Galan, Francisco Javier Lucas-Imbernón. (53) Hospital Virgen de la Luz (Cuenca): Félix González Martínez, Diana Moya Olmeda. (54) Hospital Nuestra Señora del Prado de Talavera de la Reina (Toledo): Ricardo Juárez. (55) Hospital Universitario de Canarias (Tenerife): Patricia Eiroa Hernandez, Jose Francisco Fernandez Rodriguez. (56) Hospital Universitario de Gran Canaria Dr. Negrín: José Pavón Monzo, Nayra Cabrera González. (57) Hospital Universitario Central Asturias: Pablo Herrero Puente, Desire María Velarde Herrera. (58) Hospital Universitario de Cabueñes (Gijón): Carmen Elvira Menéndez, Ana Murcia Olagüenaga. (59) Hospital Clínico Universitario Virgen de la Arrixaca: Eva Quero Motto, Nuria Tomas García. (60) Hospital General Universitario Reina Sofía de Murcia: Ines García Rosa, María Encarnación Sanchez Canovas, María Consuelo Quesada Martínez. (61) Hospital San Pedro de Logroño: Noemí Ruiz de Lobera. (62) Hospital Clínico Universitario Lozano Blesa: Jose María Ferreras Amez, Belen Arribas Entrala.

      • Contributors All the authors discussed the idea and design of study and provided patients. Data analysis and first draft writing were done by ÒM. All authors read the draft and provided insight for the final version. ÒM is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.