Differential Diagnosis between Sintilimab-related Autoimmune Myocarditis and Acute Myocardial Infarction
Yihe Wu1,2, Jiayun Nian1, Hongxu Liu3
1Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Biological Procedures Online
|March 3, 2026
Summary
Sintilimab-related autoimmune myocarditis presents with nonspecific symptoms in elderly men, often occurring early in treatment. Differentiating it from acute myocardial infarction requires careful review of medication history and diagnostic tests like cardiac MRI.
Area of Science:
- Oncology
- Immunology
- Cardiology
Background:
- Immune checkpoint inhibitors like sintilimab can induce immune-related adverse events.
- Autoimmune myocarditis is a rare but serious side effect of sintilimab therapy.
- Distinguishing sintilimab-induced myocarditis from acute myocardial infarction is clinically challenging.
Purpose of the Study:
- To analyze the clinical features and diagnostic patterns of sintilimab-related autoimmune myocarditis.
- To identify key differential diagnostic points between sintilimab-related autoimmune myocarditis and acute myocardial infarction.
Main Methods:
- Systematic literature search for sintilimab-related autoimmune myocarditis case reports up to April 2024.
- Retrospective analysis of medical records from Beijing Hospital of Traditional Chinese Medicine over the past three years.
- Collected case reports and medical records were subjected to statistical analysis.
Main Results:
- Twenty-three cases were analyzed (22 case reports, 1 medical record).
- Affected individuals were predominantly elderly men (60-75 years), with onset typically between the first and second sintilimab doses.
- Common symptoms included chest tightness and palpitations, with occasional myasthenia gravis-like symptoms; cardiac biomarkers and ECG changes were frequent, while reduced ejection fraction was rare.
Conclusions:
- Sintilimab-related autoimmune myocarditis exhibits nonspecific clinical manifestations.
- Medication history and associated symptoms are crucial for early suspicion.
- Coronary angiography, cardiovascular magnetic resonance, and myocardial biopsy aid in diagnosis and differentiation from acute myocardial infarction.
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