Clinical Presentation and Outcomes of Acute Pericarditis in a Large Urban Hospital in the United States of America

Abstract

Background: Acute pericarditis is the most common presentation of pericardial diseases. Although generally benign, complications such as constrictive pericarditis, cardiac tamponade, and recurrence can occur.

Research question: What are the clinical factors associated with adverse outcomes in acute pericarditis?

Study design and methods: We used an informatics-based search engine to search for International Classification of Diseases codes related to pericardial disease between January 1, 2009 and November 14, 2018 and then extracted clinical information, including only patients meeting the European Society of Cardiology criteria for acute pericarditis. We then evaluated the predictive value of clinical characteristics for adverse outcomes (cardiac tamponade, constrictive pericarditis, failure of therapy, recurrences, or death).

Results: We identified 240 patients with a first episode of pericarditis (51 [34-62] years, 56% males and 50% white). Pericarditis was determined to be idiopathic in 126 (53%) cases and related to cardiac injury in 79 (33%). During a median follow-up time of 179 (20-450) days, 82 (34%) patients experienced at least one adverse outcome. Subacute presentation was an independent predictor of adverse outcomes. Patients with postcardiac injury pericarditis had a lower incidence in the composite of failure of treatment and recurrence (13% vs 26%; P = .022) compared with patients with idiopathic pericarditis. Troponin I measurements were obtained in 167 patients (70%). Elevated troponin I levels were associated with lower incidence of recurrences (4% vs 17%; P = .024) and of the composite outcome (13% vs 36%; P = .004).

Interpretation: Acute pericarditis is associated with at least one adverse outcome in 34% of patients. Subacute presentation and idiopathic etiology are associated with higher incidence of adverse outcomes, whereas elevated troponin I levels identify a group with reduced risk of recurrences.

Keywords: acute pericarditis; recurrence; subacute presentation; therapy failure; troponin I.

Figure 1

A, Etiology of acute pericarditis. The pie chart shows the prevalence of various acute pericarditis etiologies in the cohort. B, Adverse outcomes. The column chart shows the incidence of adverse outcomes in the cohort.

Figure 2

Forest plot for the prediction of the composite adverse outcome. Logistic regression multivariate model for the prediction of the composite adverse outcome (tamponade, constrictive pericarditis, failure of treatment, clinical recurrences, or death). Statistical significant values are presented in bold character. MI = myocardial infarction.

Figure 3

A, Treatment failure or clinical recurrences in idiopathic and postcardiac injury pericarditis. The column chart shows the incidence of treatment failure or clinical recurrences in patients with idiopathic pericarditis and postcardiac injury pericarditis. The column chart shows the incidence of treatment failure or clinical recurrences in patients with idiopathic pericarditis and postcardiac injury pericarditis. B, Adverse outcome in patients with and without troponin I positivity. The column chart shows the incidence of adverse outcome in patients with and without troponin I positivity.