Abstract
26-A-14594-ACC ADVERSE CARDIAC OUTCOMES AND THE IMPACT OF MYOCARDITIS SEVERITY IN PATIENTS WITH IMMUNE CHECKPOINT INHIBITOR-ASSOCIATED MYOCARDITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Journal of the American College of Cardiology, Vol.87(13 Supplement), p.A1105
04/2026
DOI: 10.1016/j.jacc.2026.02.2709
Abstract
Background
Immune checkpoint inhibitor (ICI)-associated myocarditis, though rare at <1% of the population, carries high morbidity and mortality. The magnitude of impact of the severity of ICI myocarditis on adverse outcomes is not well known.
Methods
We conducted a meta-analyses comparing adverse events between myocarditis grades 1-2 versus 3-4, and grades 1-3 versus 4. We searched PubMed, Embase, Scopus, and Web of Science, from inception through 11/15/2023, for studies evaluating ICIs and myocarditis. We extracted patient characteristics, myocarditis grading, and adverse cardiac outcomes. Pooled estimate in odds ratios (ORs) and respective 95% confidence intervals (CIs) were derived using a random-effects model.
Results
Seven studies (n=159, mean age 66 years, 56% male) were included. Corticosteroids were first-line therapy; adjunct immunosuppressants varied. Pooled adverse cardiac outcomes occurred in 19% (95% CI, 14-26%). Compared with grade 1-2, grade 3-4 myocarditis had an OR of 8.25 (95% CI, 0.97-70.54; p=0.054). Grade 4 vs grade 1-3 showed OR 32.58 (95% CI, 6.39-166.04; p<0.001) [Figure 1]. All patients with ventricular arrhythmias or complete heart block died, indicating a poor prognosis.
Conclusion
Adverse outcomes in ICI myocarditis are strongly linked to severity, with fulminant disease (grade 4) conferring the greatest risk. These findings emphasize the prognostic value of standardized grading and the urgent need for uniform management strategies.
Details
- Title: Subtitle
- 26-A-14594-ACC ADVERSE CARDIAC OUTCOMES AND THE IMPACT OF MYOCARDITIS SEVERITY IN PATIENTS WITH IMMUNE CHECKPOINT INHIBITOR-ASSOCIATED MYOCARDITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
- Creators
- Bilal Saeed - University of IowaMehul Adhaduk - University of IowaAdam Blaine - University of IowaBhavana Sirimalle - University of Iowa Hospitals and ClinicsArnav Umesh - University of Iowa Hospitals and ClinicsPaari Dominic - University of IowaKimberly Sue Delcour - University of IowaErnesto Ruiz Duque - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of the American College of Cardiology, Vol.87(13 Supplement), p.A1105
- DOI
- 10.1016/j.jacc.2026.02.2709
- ISSN
- 0735-1097
- Publisher
- Elsevier
- Language
- English
- Date published
- 04/2026
- Academic Unit
- Cardiovascular Medicine; Anesthesia; General Internal Medicine; Internal Medicine
- Record Identifier
- 9985149573902771
Metrics
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