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The Incidence of Myocarditis and Pericarditis in Post COVID-19 Unvaccinated Patients-A Large Population-Based Study Ortal Tuvali^ 1 , Sagi Tshori^ 2 , Estela Derazne^ 3 , Rebecca Regina Hannuna^ 2 , Arnon Afek^ 3 4 , Dan Haberman^ 1 , Gal Sella^ 1 , Jacob George^ 1 Affiliations Expand Affiliations * ^1 Heart Center, Kaplan Medical Center, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel. * ^2 Research Authority, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel. * ^3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel. * ^4 General Management, The Chaim Sheba Medical Centre, Tel Hashomer, Ramat-Gan 52621, Israel. * PMID: 35456309 * PMCID: PMC9025013 * DOI: 10.3390/jcm11082219 Free PMC article Item in Clipboard The Incidence of Myocarditis and Pericarditis in Post COVID-19 Unvaccinated Patients-A Large Population-Based Study Ortal Tuvali et al. J Clin Med. 2022. Free PMC article Show details Display options Display options Format [Abstract] J Clin Med Actions * Search in PubMed * Search in NLM Catalog * Add to Search . 2022 Apr 15;11(8):2219. doi: 10.3390/jcm11082219. Authors Ortal Tuvali^ 1 , Sagi Tshori^ 2 , Estela Derazne^ 3 , Rebecca Regina Hannuna^ 2 , Arnon Afek^ 3 4 , Dan Haberman^ 1 , Gal Sella^ 1 , Jacob George^ 1 Affiliations * ^1 Heart Center, Kaplan Medical Center, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel. * ^2 Research Authority, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel. * ^3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel. * ^4 General Management, The Chaim Sheba Medical Centre, Tel Hashomer, Ramat-Gan 52621, Israel. * PMID: 35456309 * PMCID: PMC9025013 * DOI: 10.3390/jcm11082219 Item in Clipboard Full text links Cite Display options Display options Format [Abstract] Abstract Myocarditis and pericarditis are potential post-acute cardiac sequelae of COVID-19 infection, arising from adaptive immune responses. We aimed to study the incidence of post-acute COVID-19 myocarditis and pericarditis. Retrospective cohort study of 196,992 adults after COVID-19 infection in Clalit Health Services members in Israel between March 2020 and January 2021. Inpatient myocarditis and pericarditis diagnoses were retrieved from day 10 after positive PCR. Follow-up was censored on 28 February 2021, with minimum observation of 18 days. The control cohort of 590,976 adults with at least one negative PCR and no positive PCR were age- and sex-matched. Since the Israeli vaccination program was initiated on 20 December 2020, the time-period matching of the control cohort was calculated backward from 15 December 2020. Nine post-COVID-19 patients developed myocarditis (0.0046%), and eleven patients were diagnosed with pericarditis (0.0056%). In the control cohort, 27 patients had myocarditis (0.0046%) and 52 had pericarditis (0.0088%). Age (adjusted hazard ratio [aHR] 0.96, 95% confidence interval [CI]; 0.93 to 1.00) and male sex (aHR 4.42; 95% CI, 1.64 to 11.96) were associated with myocarditis. Male sex (aHR 1.93; 95% CI 1.09 to 3.41) and peripheral vascular disease (aHR 4.20; 95% CI 1.50 to 11.72) were associated with pericarditis. Post COVID-19 infection was not associated with either myocarditis (aHR 1.08; 95% CI 0.45 to 2.56) or pericarditis (aHR 0.53; 95% CI 0.25 to 1.13). We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection. Keywords: COVID-19; myocarditis; pericarditis. Conflict of interest statement The authors declare no conflict of interest. Figures Figure 1 Figure 1 Study profile, design and timelines.... Figure 1 Study profile, design and timelines. 'clalit' = Clalit Health Services. Vaccination = COVID-19... Figure 1 Study profile, design and timelines. 'clalit' = Clalit Health Services. Vaccination = COVID-19 vaccination. PCR -/+ = negative/ positive COVID-19 PCR. (A). Flowchart of patient selection in COVID and control cohorts. (B). Research timeline from first PCR in 7 March 2020 to the end of study (lower part). The COVID cohort is depicted in the upper part, and the matching period of the control cohort is depicted in the middle. Figure 2 Figure 2 Kaplan-Meier estimates of cumulative probability... Figure 2 Kaplan-Meier estimates of cumulative probability of myocarditis ( A ) and pericarditis (... Figure 2 Kaplan-Meier estimates of cumulative probability of myocarditis (A) and pericarditis (B) in COVID-19 and control cohorts during 6 months. See this image and copyright information in PMC Similar articles * Epidemiology of Myocarditis and Pericarditis Following mRNA Vaccination by Vaccine Product, Schedule, and Interdose Interval Among Adolescents and Adults in Ontario, Canada. Buchan SA, Seo CY, Johnson C, Alley S, Kwong JC, Nasreen S, Calzavara A, Lu D, Harris TM, Yu K, Wilson SE. Buchan SA, et al. JAMA Netw Open. 2022 Jun 1;5(6):e2218505. doi: 10.1001/ jamanetworkopen.2022.18505. JAMA Netw Open. 2022. PMID: 35749115 Free PMC article. * SARS-CoV-2 Vaccination and Myocarditis in a Nordic Cohort Study of 23 Million Residents. Karlstad O, Hovi P, Husby A, Harkanen T, Selmer RM, Pihlstrom N, Hansen JV, Nohynek H, Gunnes N, Sundstrom A, Wohlfahrt J, Nieminen TA, Grunewald M, Gulseth HL, Hviid A, Ljung R. Karlstad O, et al. JAMA Cardiol. 2022 Jun 1;7(6):600-612. doi: 10.1001/ jamacardio.2022.0583. JAMA Cardiol. 2022. PMID: 35442390 Free PMC article. * Prevalence and clinical outcomes of myocarditis and pericarditis in 718,365 COVID-19 patients. Buckley BJR, Harrison SL, Fazio-Eynullayeva E, Underhill P, Lane DA, Lip GYH. Buckley BJR, et al. Eur J Clin Invest. 2021 Nov;51 (11):e13679. doi: 10.1111/eci.13679. Epub 2021 Sep 18. Eur J Clin Invest. 2021. PMID: 34516657 Free PMC article. * Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review. Pillay J, Gaudet L, Wingert A, Bialy L, Mackie AS, Paterson DI, Hartling L. Pillay J, et al. BMJ. 2022 Jul 13;378:e069445. doi: 10.1136/bmj-2021-069445. BMJ. 2022. PMID: 35830976 Free PMC article. Review. * Risk of myopericarditis following COVID-19 mRNA vaccination in a large integrated health system: A comparison of completeness and timeliness of two methods. Sharff KA, Dancoes DM, Longueil JL, Johnson ES, Lewis PF. Sharff KA, et al. Pharmacoepidemiol Drug Saf. 2022 Aug;31(8):921-925. doi: 10.1002/pds.5439. Epub 2022 Apr 16. Pharmacoepidemiol Drug Saf. 2022. PMID: 35404496 Free PMC article. See all similar articles Cited by * Catecholamines Are the Key Trigger of COVID-19 mRNA Vaccine-Induced Myocarditis: A Compelling Hypothesis Supported by Epidemiological, Anatomopathological, Molecular, and Physiological Findings. Cadegiani FA. Cadegiani FA. Cureus. 2022 Aug 11;14(8):e27883. doi: 10.7759/cureus.27883. eCollection 2022 Aug. Cureus. 2022. PMID: 35971401 Free PMC article. Review. 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