Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2023 Jan 31;18(1):e0281296. doi: 10.1371/journal.pone.0281296. eCollection 2023.
Clinical courses of acute myocarditis are heterogeneous in populations and geographic regions. There is a dearth of long-term outcomes data for acute myocarditis prior to the coronavirus disease pandemic, particularly in the older and female population. This study aimed to provide the nationwide epidemiologic approximates of clinically suspected acute myocarditis across adults of all ages over the long term.
From the nationwide governmental health insurance database, a retrospective cohort comprised all patients aged 20-79 who were hospitalized for clinically suspected acute myocarditis without underlying cardiac diseases from 2006 to 2018. The complicated phenotype was defined as requiring hemodynamic or major organ support. Over 10 years, all-cause mortality and index event-driven excess mortality were evaluated according to young-adult (20-39 years), mid-life (40-59 years), and older-adult (60-79 years) age groups.
Among 2,988 patients (51.0±16.9 years, 46.2% women), 362 (12.1%) were of complicated phenotype. Of these, 163 (45.0%) had died within 1 month. All-cause death at 30 days occurred in 40 (4.7%), 52 (4.8%), and 105 (10.0%) patients in the young-adult, mid-life, and older-adult groups, respectively. For 10 years of follow-up, all-cause death occurred in 762 (25.5%). Even in young adult patients with non-complicated phenotypes, excess mortality remained higher compared to the general population.
In hospitalized patients with clinically suspected acute myocarditis, short-term mortality is high both in young and older adults, particularly those with comorbidities and severe clinical presentation. Furthermore, excess mortality remains high for at least 10 years after index hospitalization in young adults.
急性心肌炎在不同人群和地理区域的临床病程存在异质性。在冠状病毒病大流行之前，急性心肌炎的长期结局数据匮乏，尤其是在老年和女性人群中。本研究旨在提供长期范围内所有年龄段成年人中临床疑似急性心肌炎的全国性流行病学估计。
从全国性政府医疗保险数据库中，回顾性纳入了 2006 年至 2018 年期间因无基础心脏疾病住院的所有 20-79 岁临床疑似急性心肌炎患者。复杂表型定义为需要血流动力学或主要器官支持。在 10 年期间，根据青年（20-39 岁）、中年（40-59 岁）和老年（60-79 岁）年龄组评估全因死亡率和指数事件驱动的超额死亡率。
在 2988 例患者中（51.0±16.9 岁，46.2%为女性），362 例（12.1%）为复杂表型。其中，163 例（45.0%）在 1 个月内死亡。30 天全因死亡率分别为青年组 40 例（4.7%）、中年组 52 例（4.8%）和老年组 105 例（10.0%）。10 年随访期间，全因死亡 762 例（25.5%）。即使在非复杂表型的青年患者中，与普通人群相比，超额死亡率仍较高。
在临床疑似急性心肌炎的住院患者中，青年和老年患者的短期死亡率均较高，尤其是合并症和严重临床表现的患者。此外，指数住院后至少 10 年内，青年患者的超额死亡率仍较高。
