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. 2023 Jun 25;44(24):2234-2243.
doi: 10.1093/eurheartj/ehad339.

COVID-19 vaccination-related myocarditis: a Korean nationwide study

Jae Yeong Cho  1   2 , Kye Hun Kim  1   2 , Nuri Lee  2   3 , Soo Hyeon Cho  4 , Seung Yun Kim  4 , Eun Kyoung Kim  4 , Jae-Hyeong Park  5 , Eui-Young Choi  6 , Jin-Oh Choi  7 , Hyukjin Park  3 , Hyung Yoon Kim  2 , Hyun Ju Yoon  1   2 , Youngkeun Ahn  1   2 , Myung Ho Jeong  1   2 , Jeong Gwan Cho  1   2
Affiliations

COVID-19 vaccination-related myocarditis: a Korean nationwide study

Jae Yeong Cho et al. Eur Heart J. .

Abstract

Aims: A comprehensive nationwide study on the incidence and outcomes of COVID-19 vaccination-related myocarditis (VRM) is in need.

Methods and results: Among 44 276 704 individuals with at least 1 dose of COVID-19 vaccination, the incidence and clinical courses of VRM cases confirmed by the Expert Adjudication Committee of the Korea Disease Control and Prevention Agency were analyzed. COVID-19 VRM was confirmed in 480 cases (1.08 cases per 100 000 persons). Vaccination-related myocarditis incidence was significantly higher in men than in women (1.35 vs. 0.82 per 100 000 persons, P < 0.001) and in mRNA vaccines than in other vaccines (1.46 vs. 0.14 per 100 000 persons, P < 0.001). Vaccination-related myocarditis incidence was highest in males between the ages of 12 and 17 years (5.29 cases per 100 000 persons) and lowest in females over 70 years (0.16 cases per 100 000 persons). Severe VRM was identified in 95 cases (19.8% of total VRM, 0.22 per 100 000 vaccinated persons), 85 intensive care unit admission (17.7%), 36 fulminant myocarditis (7.5%), 21 extracorporeal membrane oxygenation therapy (4.4%), 21 deaths (4.4%), and 1 heart transplantation (0.2%). Eight out of 21 deaths were sudden cardiac death (SCD) attributable to VRM proved by an autopsy, and all cases of SCD attributable to VRM were aged under 45 years and received mRNA vaccines.

Conclusion: Although COVID-19 VRM was rare and showed relatively favorable clinical courses, severe VRM was found in 19.8% of all VRM cases. Moreover, SCD should be closely monitored as a potentially fatal complication of COVID-19 vaccination.

Keywords: COVID-19; Myocarditis; Outcomes; Vaccination.

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Conflict of interest statement

Conflict of interest All authors declare no conflict of interest for this contribution.

Figures

Structured Graphical Abstract
Structured Graphical Abstract
Study flowchart and summary of the percentage of patients with adverse outcomes among 480 cases of COVID-19 vaccination-related myocarditis. VRM, vaccine-related myocarditis; SCD, sudden cardiac death; ICU, intensive care unit; ECMO, extracorporeal membrane oxygenation
Figure 1
Figure 1
Time from COVID-19 vaccination to symptom onset.
Figure 2
Figure 2
Kaplan–Meier estimates of the incidence of COVID-19 vaccine-related myocarditis. (A) Cumulative incidence per 100 000 persons in the total vaccinated population and males and females between age 12 and 17 and (B) cumulative incidence per 100 000 persons in the total vaccinated population according to vaccine type.
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