Acute idiopathic pericarditis: the importance of guideline-based treatment to avoid recurrence

Abstract Background Acute pericarditis (AP) usually resolves with first-line treatment, but it may recur. Recurrences are attributed to a deranged immunity, is unclear if they also be related inappropriate treatment. Purpose The aim of our study was clarify the potential role treatment on relapse episodes in AP. Methods Consecutive patients prospectively followed-up over 20 years at Padua University Cardio-immunology outpatient clinic were included. Clinical and instrumental findings recorded diagnosis each follow-up. Spectrum, appropriateness, efficacy side effects therapies received by before after referral centre considered. distribution recurrence-free survival probability estimated using Kaplan-Meier method; impact covariates interest outcome assessed Cox univariate analysis models. Results included 144 (57% male, mean age 50 years, 143 Caucasian 1 African). 139 had AP, which recurrent 63; 5 constrictive pericarditis. Etiology idiopathic/presumed-viral 112 patients, bacterial 1, secondary pericardial injury 26, Dressler syndrome 2, systemic immune-mediated disease 3. At diagnosis, 68% NYHA class I; 9% developed cardiac tamponade; 84% non-steroidal-anti-inflammatory drugs (NSAIDs), 54% colchicine 19% corticosteroids. Treatment not line ESC guidelines 31% for NSAIDs, 12% steroids 28% colchicine, requiring readjustment. All underwent uncomplicated pericardiectomy. No patient dead last Estimated recurrence-free-survival 86% 1st year, 58% 5th, 52% 10th. Variables tended associated higher risk recurrence were: tamponade left heart failure, concomitant diseases, history recurrence, III or IV diagnosis. acute/recurrent forms did appear international recommendations terms daily dosage duration, both, 43 17 corticosteroids 39 omitted despite absence contraindications (Table 1). Following adjustment guidelines, 107 relapsing obtained complete remission; only 13 (9%) AP showed truly treatment-refractory form that required second-line therapy. Conclusion When treated according has favorable course, even its most adverse presentations. inaccuracies seems account, least part, recurrences. Funding Acknowledgement Type funding sources: None.