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Myocarditis and coronavirus disease 2019 vaccination: A systematic review and meta-summary of cases

Pandit Bagus Tri Saputra1, Roy Bagus Kurniawan2, Desy Trilistyoati2

  • 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr Soetomo General Academic Hospital, Surabaya, Indonesia.

Biomolecules & Biomedicine
|February 21, 2023
PubMed

Insights

COVID-19 vaccination can cause myocarditis, primarily in males after the second mRNA dose. This condition is typically mild, with most patients recovering well with standard treatments.

Area of Science:

  • Cardiology
  • Immunology
  • Public Health

Background:

  • Myocarditis following COVID-19 vaccination is a growing public concern.
  • Understanding its characteristics and outcomes is crucial for vaccine safety monitoring.

Approach:

  • Systematic review of 396 individual patient cases of myocarditis post-COVID-19 vaccination (Jan 2020-Sep 2022).
  • Included case reports and series, excluding reviews.
  • Utilized Joanna Briggs Institute critical appraisals for bias assessment and performed statistical analyses.

Key Points:

  • Majority of myocarditis cases occurred in males after the second mRNA vaccine dose, with chest pain as the primary symptom.
  • Previous COVID-19 infection significantly increased myocarditis risk after the first dose, suggesting an immune-mediated mechanism.
  • Non-infective subtypes dominated histopathology; ECG and cardiac markers were sensitive screening tools, while cardiac MRI confirmed diagnosis.

Conclusions:

  • Myocarditis post-COVID-19 vaccination is generally benign, with short hospital stays (<5 days), low ICU admission (<12%), and mortality (<2%).
  • Treatment commonly involved NSAIDs, colchicine, and steroids.
  • Fatal cases were associated with female sex, older age, non-chest pain symptoms, first-dose vaccination, and severe cardiac dysfunction.

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