Meta-analysis details short-term outcomes of SARS-CoV-2 mRNA vaccine-associated myopericarditis in adolescents and young adults

1. In a systematic review and meta-analysis of COVID vaccine-associated myopericarditis in adolescents and young adults, short-term outcomes were generally favorable.

2. Hospitalization for COVID vaccine-associated myopericarditis was associated with a short length of stay, rarely required inotropic support, and was not associated with death.

Evidence Rating Level: 2 (Good)

Study Rundown: COVID mRNA vaccine-associated myopericarditis is a rare but serious adverse event that has been reported in young adults and adolescents. In adults, vaccine-related myocarditis typically resolves with minimal complications and preservation of cardiac function. However, clinical outcomes of COVID vaccine-associated myopericarditis have not been well studied in adolescents and young adults. This systematic review and meta-analysis investigated early outcomes associated with myopericarditis after COVID vaccination in children and young adolescents aged 12-20 years old. In general, myopericarditis occurred more frequently after the second dose of the COVID vaccine and was almost exclusively seen in males. Nearly all patients with myopericarditis were hospitalized, with an average length of stay of 2.8 days. About 15% of patients with myopericarditis had decreased left ventricular (LV) systolic function, although roughly 1% had severe LV dysfunction. In addition, vaccine-associated myopericarditis was not associated with death or the use of mechanical respiratory support. The most significant limitation of this study is the lack of long-term follow-up information regarding complications from vaccine-associated myopericarditis  In general, this study suggests that vaccine-associated myopericarditis is rare and that short-term outcomes are favorable; however, larger studies with longer follow-up periods are necessary to further inform our understanding of this condition.

Click here to read the article in JAMA Pediatrics

Relevant Reading: Myocarditis after RNA-based vaccines for coronavirus

In-Depth [systematic review and meta-analysis]: This systematic review and meta-analysis included all observational studies from inception to August 25, 2022, describing myopericarditis after COVID-19 vaccination. 1406 potential articles were identified, with 23 articles included in the systematic review and 12 studies included in a meta-analysis. The incident rate of COVID vaccine-associated myopericarditis was higher after the second dose of the vaccine compared to the first, with 74.4% (95%CI, 58.2%-90.5%) of total events occurring after the second dose. Common symptoms included chest pain (83.7% of patients [95% CI, 72.7-94.6], p<0.001), fever (44.5% of patients [95% CI, 16.9-72.0, p<0.001], and headache (33.3% of patients [95% CI, 8.6-58.0, p<0.001]. The most common markers of myopericarditis included elevated troponin in 84.5% (95% CI, 75.1%-94.5%) of patients and ST-segment elevation or depression in 53.0% (95% CI, 34.6%-71.3%) of patients. Most patients had preserved LV systolic function (84.4% of patients [95%CI, 80.5%-88.3%]). Overall, 92.6% (95%CI, 87.8%-97.3%) of patients required hospitalization, with 23.2% (95% CI, 11.7%-34.7%) requiring ICU admission. Despite ICU admissions, only 1.3% (95%CI, 0%-2.7%) of patients required inotropic support, with no deaths or mechanical ventilation, and had an average length of stay of 2.8 days (95%CI, 2.1-3.5).

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