Outcomes of acute pericarditis with an inflammatory phenotype.

BACKGROUND

Patients with pericarditis may show elevation of C-reactive protein (CRP) and pericardial effusion at presentation. There are limited data on the prognostic implications of this inflammatory phenotype.

OBJECTIVES

Aim of the present study is to evaluate the outcome of the inflammatory phenotype in a cohort of patients with acute pericarditis.

METHODS

Observational cohort study of consecutive adult patients with acute pericarditis in 4 referral centers for pericarditis (Athens, Milan, Turin, Udine).

RESULTS

Our cohort included 918 patients with acute pericarditis (median age of 56, IQR 28 years, 55.6 % females). The etiology of pericarditis was respectively idiopathic in 82.1 %, post-cardiac injury syndrome in 9.3 %, and systemic inflammatory disease in 4.9 % of cases. CRP elevation was detected at presentation in 778 cases (84.7 %), an inflammatory phenotype (CRP elevation and pericardial effusion) was found in 557 patients (60.7 %). Baseline medical therapy included a NSAID in 74.9 %, colchicine 70.9 %, and corticosteroids 25.1 % of cases. After a mean follow-up of 22.5 months, patients with an inflammatory phenotype had a higher recurrence rate at 18 months (respectively 46.0 % vs. 31.0 %; p < 0.0001), and a shorter recurrence-free survival (Log-rank p = 0.0001). In multivariable analysis the inflammatory phenotype presentation was independently associated with an increased risk of recurrences (OR 2.005, 95 % CI 1.454 to 2.765; p < 0.0001).

CONCLUSIONS

The inflammatory phenotype of presentation of acute pericarditis is associated with an increased risk of recurrences, highlighting the importance of timely individualized therapy and close follow-up for these patients.