Cardio · pericardial-myocardial-other
Acute pericarditis: diagnosis and colchicine
Fellowship-level guide to acute pericarditis under the 2025 ESC myocarditis and pericarditis guideline, with the 2015 ESC pericardial guideline as history and the 2023 ESC and 2025 ACC/AHA acute coronary syndrome guidelines for pericarditis after myocardial infarction: the ESC 2025 diagnostic criteria, high-risk features and admission, aspirin or NSAID with colchicine as an adjunct, and their doses, corticosteroid rows, incessant and recurrent pericarditis, anti-IL-1 agents for recurrent pericarditis after failure of first-line therapies and corticosteroids with elevated C-reactive protein, post-cardiac injury syndromes, the colchicine trials, and Australian population data.
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Red flags
- ESC 2025 high-risk pericarditis (Table 7): signs and symptoms of cardiac tamponade, fever above 38 °C, effusive–constrictive pericarditis, failure of NSAID therapy or incessant pericarditis, and on imaging a large effusion (>20 mm end-diastole), cardiac tamponade or extensive pericardial LGE on CMR; hospital admission is recommended for monitoring and treatment (Class I, Level B)
- ST elevation with an acute coronary pathology is typically regional and often accompanied by reciprocal ST depression; in pericarditis it is often diffuse or global, without reciprocal changes (Fifth UDMI, 2026)
- A post-MI pericardial effusion of more than 10 mm at end-diastole should be investigated for possible subacute heart rupture (ESC 2025)
- Corticosteroids are not recommended as the first option for pericarditis without a specific indication (ESC 2025, Class III, Level C)
This page covers the first episode of acute pericarditis: diagnosis, triage, first-line drugs and colchicine, then incessant and recurrent disease and pericarditis after myocardial infarction (MI) or cardiac surgery. ESC 2025 notes that pericarditis guidelines had been published twice before, while myocarditis is covered in a guideline for the first time.[1]
- Related topic: STEMI: reperfusion.
- Related topic: Cardiac tamponade.
Overview and definitions
Picture a young adult with sharp chest pain that is worse lying flat and better sitting forward.[1] ESC 2025 defines acute pericarditis as an inflammatory pericardial syndrome with or without pericardial effusion and an onset of 4 weeks or less.[1]
ESC 2025 introduces a new umbrella category, inflammatory myopericardial syndrome (IMPS), to increase understanding of the potential overlap between myocarditis and pericarditis.[1]
Terminology and stages (ESC 2025, Table 3; pericardial rows and footnotes)
| Term | ESC 2025 definition |
|---|---|
| Acute pericarditis | Duration of symptoms ≤4 weeks |
| Subacute/incessant pericarditis | Duration of symptoms >4 weeks to ≤3 months |
| Incessant (footnote) | Persistent symptoms without a symptom-free interval of >4 weeks despite full-dose guideline-directed medical therapy (including corticosteroids), or relapse early during tapering |
| Chronic myocarditis/pericarditis | Duration of symptoms >3 months |
| Recurrent myocarditis/pericarditis | New symptoms or disease activity after clinical remission |
| Remission without residuals | Regression or absence of symptoms, with normalisation of ECG, biomarkers and imaging abnormalities (echocardiography and CMR) |
| Myopericarditis | Predominant pericarditis: definite criteria for pericarditis and elevated biomarkers of myocardial injury, without newly developed regional or global impairment of left ventricular (LV) function on echocardiography or CMR |
| Perimyocarditis | Predominant myocarditis: the same, but with newly developed regional or global impairment of LV function |
Recurrent pericarditis has a stricter definition in the text.[1] ESC 2025 defines it as a relapse after a documented first episode of acute pericarditis, a symptom-free interval, complete discontinuation of anti-inflammatory therapy, and evidence of subsequent recurrence of pericarditis.[1] The task force uses "incessant" for persistent symptoms without clear remission, including symptom persistence or recurrence during drug tapering.[1]
[1]Epidemiology and causes
ESC 2025 estimates the incidence of acute pericarditis at about 3–32 cases per 100 000 person-years, and says men and younger individuals are more likely to be diagnosed.[1] Pericarditis is diagnosed in 0.2% of all cardiovascular in-hospital admissions.[1]
The cause depends on where you practise.[1] ESC 2025 says idiopathic or viral pericarditis is the most frequent aetiology in developed countries, ranging from 50% in inpatient settings to more than 80% in outpatient settings.[1] Tuberculosis is responsible for about 70% of all cases in regions where it is endemic, especially in people with HIV infection.[1]
- Post-cardiac injury syndrome (PCIS): an increasing number of cases follow interventional procedures and surgery, because of the increased number of procedures and the ageing population (ESC 2025).[1]
- Other common causes (ESC 2025): systemic inflammatory or autoimmune diseases and cancer, especially lung and breast cancer or lymphomas and leukaemia.[1]
- Genetic: ESC 2025 reports genetic mutations in about 5%–15% of patients with recurrence, sometimes related to a monogenic autoinflammatory disease, mainly familial Mediterranean fever (FMF) and tumour necrosis factor receptor-associated periodic syndrome (TRAPS).[1]
Pathophysiology
The pain and the rub come from the same place.[1] ESC 2025 attributes the typical pain to increased attrition between inflamed pericardial layers, and the friction rub to friction between the two inflamed layers.[1]
The ECG changes come from somewhere else.[1] ESC 2025 says the pericardium is electrically silent, so ECG changes imply concomitant inflammation of the myocardium and warrant investigation for concurrent myocarditis.[1] It describes the changes as indicative of inflammation of the subepicardium.[1]
Inflammatory phenotype
ESC 2025
- Inflammation of the pericardium with evidence of systemic inflammation
- ESC 2025 says an inflammatory syndrome is usually present in acute pericarditis, with fever above 38 °C (70%), raised CRP (80%–90%), ESR, neutrophil leucocytosis and pericardial and/or pleural effusion (approximately 50%), and labels this presentation the inflammatory phenotype
- These forms typically respond well to targeted anti-inflammatory therapies, including colchicine and anti-IL-1 agents
Non-inflammatory phenotype
ESC 2025
- Pericarditis without CRP elevation, or with low elevation of markers of systemic inflammation such as high-sensitivity CRP
- Occurs in 10%–20% of patients with pericarditis
- The pathogenesis of pericarditis with normal C-reactive protein is unknown and these cases are often difficult to treat
ESC 2025 says some inflammatory forms of recurrent pericarditis share similarities with genetic autoinflammatory diseases characterised by periodic fevers, such as FMF and TRAPS.[1] ESC 2025 says the most common monogenic autoinflammatory syndromes include FMF, in which serositis episodes last only 1–3 days, and TRAPS, in which fever and symptoms last for weeks.[1] It says these conditions are characterised by the exaggerated production of IL-1 by the inflammasome, and that associated mutations have been reported in up to 10% of patients with multiple recurrences, especially with a positive family history and a poor response to colchicine.[1]
Clinical presentation
Chest pain is the usual reason the patient arrives.[1] ESC 2025 says the main presenting symptom is usually chest pain (85%–90% of cases), typically sharp and pleuritic, improved by sitting up and leaning forward, and made worse by inspiration, lying down and swallowing.[1] Left trapezius ridge pain is a classic symptom of pericardial irritation and is transmitted through the phrenic nerve.[1]
- Friction rub: up to one-third of cases; it could disappear when an effusion develops (ESC 2025).[1]
- Pericardial effusion: reported in up to 60% of cases, usually mild (ESC 2025).[1]
- ECG changes: especially PR depression as an early sign and widespread ST-segment elevation, reported in up to 60% of cases, especially in young patients; ESC 2025 says this suggests concomitant myocardial involvement, at least of mild degree.[1]
- Troponin: cardiac enzymes are usually normal, but troponin may be elevated in 20%–30% of cases because of concomitant myocarditis (myopericarditis) (ESC 2025).[1]
- Less common symptoms: shortness of breath, fever, fatigue and arrhythmia such as atrial fibrillation (AF); ESC 2025 says arrhythmic presentations are rare and usually associated with AF.[1]
- Dyspnoea: can be reported by the elderly, and right heart failure signs and symptoms in pericarditis with constriction (ESC 2025).[1]
Dry pericarditis
ESC 2025
- 40%–50% of cases; inflammation of the pericardium without pericardial effusion (also called pericarditis sicca)
- Can begin insidiously or abruptly; usually not associated with a specific cause or a worse prognosis
Effusive pericarditis
ESC 2025
- 50%–60% of cases; effusion is present
- A moderate to large effusion is more commonly associated with a non-idiopathic aetiology
Diagnostic criteria
ESC 2025 proposes new diagnostic criteria and a new classification for inflammatory myopericardial syndrome (Table 4).[1] ESC 2025 says the definite clinical diagnosis can be made with a clinical presentation and more than one additional criterion.[1] A clinical presentation with one additional criterion is possible pericarditis, and a presentation without additional criteria is unlikely or rejected.[1]
Additional criteria beyond the clinical presentation (ESC 2025, Table 4, pericarditis column)
| Category | Additional criterion for pericarditis |
|---|---|
| Clinical | Pericardial rubs |
| ECG | PR depression, widespread ST-segment elevation |
| Biomarkers | C-reactive protein elevation |
| Imaging | New or worsening pericardial effusion; pericardial oedema and/or LGE (CMR findings) |
Diagnostic certainty for pericarditis (ESC 2025, Table 4)
| Certainty | Pericarditis (ESC 2025, Table 4) |
|---|---|
| Definite | Clinical presentation with >1 additional criterion |
| Possible | Clinical presentation with 1 additional criterion |
| Unlikely/rejected | Only clinical presentation without additional criteria |
Table 4 lists chest pain or infarct-like symptoms, arrhythmias, heart failure and aborted sudden cardiac death as clinical presentations.[1] Its ECG footnote reads: if ECG changes, always consider or exclude myocarditis.[1] ESC 2025 adds that CMR can provide non-invasive confirmation of pericarditis beyond the clinical criteria.[1]
[1] [2]Differential diagnosis
ESC 2025 says it is crucial to differentiate pericarditis from other diseases, such as acute coronary syndrome (ACS), congestive heart failure, pneumonia with pleuritis, pulmonary embolism, chronic obstructive pulmonary disease and vasculitis.[1]
ST elevation raises the question of a STEMI.[5][1] The Fifth Universal Definition of MI (2026) says ST-segment elevation is not specific to MI and can also be found in pericarditis and other cardiac and non-cardiac conditions.[5] With an acute coronary pathology, it says ST-segment elevation is typically regional and often accompanied by reciprocal ST-segment depression.[5] In pericarditis or early repolarisation, ST-segment elevation is often diffuse or global, not confined to a single coronary territory, and occurs without reciprocal changes.[5]
ESC 2025: invasive coronary angiography or coronary CT, depending on clinical likelihood, is recommended in patients with IMPS if an ACS is suspected, to rule out obstructive coronary artery disease (Class I, Level C).[1] For reperfusion decisions, see STEMI: reperfusion.
Clinical and bedside assessment
For suspected IMPS, ESC 2025 recommends the basic and advanced assessments of its Table 9; the basic assessment starts with history and physical examination (below) and also includes ECG, chest X-ray, basic laboratory data and echocardiography including strain imaging.[1]
- History: potential causes and triggers (viral infection of the upper respiratory or gastrointestinal tract, toxins, drug use, medications), recurrent symptoms, family history of IMPS, cardiomyopathy or sudden cardiac death, and systemic inflammatory or autoimmune diseases.[1]
- Examination: assess clinical stability, symptoms (chest pain, heart failure symptoms, palpitations, syncope), malaise, general weakness and fatigue, a pericardial friction rub, and clinical symptoms or signs of cardiac tamponade.[1]
- Rub: ESC 2025 describes a superficial scratchy or squeaking sound.[1]
Investigations
ESC 2025: complete clinical evaluation, including history, physical examination, chest X-ray, biomarkers, ECG and echocardiography, is recommended in all patients with a suspicion of myocarditis and/or pericarditis for the initial diagnostic assessment (Class I, Level C).[1] ESC 2025: routine serology is not recommended in patients with myocarditis and/or pericarditis for the evaluation of viral aetiology, except for hepatitis C, HIV and Lyme disease (Class III, Level C).[1]
ECG
- ESC 2025: dynamic changes in the ST segment are classic hallmarks of pericarditis and myocarditis; the most typical pattern includes widespread ST-segment elevation, reported in 20%–60% of cases.[1]
- Diffuse depression of the PR segment is a classic early finding in acute pericarditis (ESC 2025).[1]
- ST-segment depression and T-wave inversion may also be present, less frequently than in acute myocardial ischaemia, and may be related to the extent of myocardial damage (ESC 2025).[1]
- Reduced QRS amplitude can be seen, especially with large effusions or extensive myocardial injury; electrical alternans has been reported, attributed to the heart swinging within a large effusion (ESC 2025).[1]
- AF can occur, especially in predisposed patients, in whom pericardial inflammation may trigger supraventricular arrhythmias (ESC 2025).[1]
- ECG changes are highly dynamic and may evolve over hours or days, and a normal ECG at presentation does not exclude IMPS (ESC 2025).[1]
Blood tests
ESC 2025 says CRP is often increased in pericarditis (up to 80%) and contributes to the diagnosis, but negative results do not exclude it.[1] In pericarditis, it calls CRP a marker of disease activity that could be used to guide the duration of anti-inflammatory therapy.[1] Troponin may be elevated in 20%–30% of cases, because of concomitant myocarditis.[1]
Imaging
Echocardiography can look normal.[1] ESC 2025 says patients with acute pericarditis may have a normal-appearing transthoracic echocardiogram (40%–50% of cases in first episodes), while new or worsening effusion is a diagnostic criterion.[1] Effusion size is the end-diastolic distance of the echo-free space between the epicardium and the parietal pericardium.[1]
Classification of pericardial effusion by size (ESC 2025, Table 10)
| Effusion size | Maximal end-diastolic diameter |
|---|---|
| Mild | <10 mm |
| Moderate | 10–20 mm |
| Large | >20 mm |
ESC 2025: CMR is recommended in patients with suspected pericarditis when a diagnosis cannot be made using clinical criteria, to assess pericardial thickening, oedema and LGE, and to assess the persistence of disease during follow-up in selected cases (Class I, Level B).[1] ESC 2025 says pericardial LGE may imply ongoing inflammation and neovascularisation rather than simple scarring.[1] Contrast-enhanced CT may be very useful to make an aetiological diagnosis in patients presenting with a large effusion, including tamponade (ESC 2025).[1]
Triage: who needs admission
Triage decides who is admitted and who is followed as an outpatient.[1] ESC 2025 says risk stratification of patients with pericarditis must be performed at the initial presentation, in the emergency department or an ambulatory setting.[1] ESC 2025: hospital admission is recommended for patients with high-risk pericarditis for monitoring and treatment (Class I, Level B).[1]
Clinical risk stratification to guide work-up (ESC 2025, Table 7, pericarditis rows)
| Risk (pericarditis row) | Clinical features | Imaging criteria |
|---|---|---|
| High risk | Signs and symptoms of cardiac tamponade; fever (temperature >38°C); effusive–constrictive pericarditis; failure of NSAID therapy; incessant pericarditis | Large effusion (>20 mm end-diastole); cardiac tamponade; extensive pericardial LGE on CMR |
| Intermediate risk | Signs and symptoms of right heart failure | Moderate–large effusion (10–20 mm end-diastole); constrictive physiology regardless of the size of the effusion |
| Low risk | Response to adequate therapy within 1–2 weeks | Absence or mild effusion; absence of pericardial LGE on CMR |
Major high-risk features or red flags in acute pericarditis (ESC 2025, Table 16)
| Feature | Hazard ratio |
|---|---|
| Fever >38°C | 3.56 |
| Subacute onset | 3.97 |
| Large pericardial effusion (>20 mm on echocardiography) | 2.15 |
| Cardiac tamponade | 2.15 |
| Lack of response to aspirin or NSAID after at least 1 week of therapy | 2.50 |
ESC 2025 says these major features were validated in multivariable analysis in a prospective cohort study of patients with acute pericarditis.[1] Its minor features are pericarditis associated with myocarditis, immunodepression, trauma and oral anticoagulant therapy.[1]
The Figure 7 footnote spells out what the triage means.[1] If a patient has one or more prognostic predictors from Table 7, a high-risk patient must be admitted to hospital, and an aetiology search should be performed.[1] Patients without high-risk features can be managed as outpatients without an aetiology search and admission if there is a good response to empirical anti-inflammatory therapy.[1] ESC 2025 says non-high-risk cases can be managed as outpatients with close follow-up within 1 to 2 weeks.[1]
ESC 2025 reports that, in the real world, approximately 25% of patients diagnosed with acute pericarditis present with at least one predictor of poor prognosis and require hospitalisation.[1] Admission allows the prompt identification and treatment of potentially life-threatening complications such as cardiac tamponade.[1] ECG changes (mainly widespread ST-segment elevation) and troponin elevation were usually not negative prognostic markers in this setting, with an infarct-like presentation and preserved biventricular function.[1]
[1]Treatment of the first episode
Aspirin or an NSAID, with colchicine as an adjunct, is first-line.[1] ESC 2025 says the mainstay of medical therapy is empirical anti-inflammatory therapy using aspirin or NSAIDs at full anti-inflammatory doses, with appropriate intervals (usually every 8 h), plus colchicine to reduce the risk of recurrences.[1] Gastroprotection with a proton pump inhibitor is recommended when NSAIDs are used.[1]
First-line and steroid rows (ESC 2025, Recommendation Table 10; selected rows)
| ESC 2025 recommendation (Recommendation Table 10) | Class | Level |
|---|---|---|
| Colchicine as first-line therapy in pericarditis, as an adjunct to aspirin/NSAID or corticosteroid therapy, to reduce subsequent recurrences | I | A |
| High-dose aspirin or NSAIDs with proton pump inhibitors as first-line therapy in pericarditis, to control symptoms and reduce recurrences | I | B |
| A β-blocker should be considered in symptomatic patients, despite full anti-inflammatory therapy, and heart rate at rest >75 b.p.m., to improve symptom control | IIa | C |
| Low- to medium-dose corticosteroids should be considered only for contraindication or failure of aspirin/NSAIDs and colchicine, or for a specific indication, to control symptoms and reduce recurrences | IIa | C |
| Corticosteroids are not recommended as the first option for pericarditis therapy without a specific indication | III | C |
The footnote to the corticosteroid rows gives examples of a specific indication: systemic inflammatory disease on maintenance corticosteroids, post-pericardiotomy syndromes, post-vaccine pericarditis, severe renal failure, and concomitant therapies interacting with NSAIDs such as oral anticoagulants.[1]
Specific initial dosing and duration (ESC 2025, Table 13; anti-inflammatory, colchicine and prednisone rows)
| Drug | Dosing | Duration | Tapering |
|---|---|---|---|
| Aspirin | 750–1000 mg 3 times daily | 1–2 weeks | Decrease by 250 mg every 1–2 weeks |
| Ibuprofen | 600–800 mg 3 times daily | 1–2 weeks | Decrease by 200 mg every 1–2 weeks |
| Indomethacin | 25–50 mg 3 times daily | 1–2 weeks | Decrease by 25 mg every 1–2 weeks |
| Colchicine | 0.5 mg once daily (<70 kg or severe renal impairment) or 0.5 mg twice daily | 3–6 months | Not required |
| Prednisone | 0.2–0.5 mg/kg/day | 2–4 weeks | Several months |
- Duration footnote: durations are initial dosing; for all treatments the attack dose is maintained until symptoms resolve and inflammatory markers (such as CRP) and other investigations (ECG, echocardiogram) normalise, and then tapering is recommended (ESC 2025, Table 13).[1]
- Which drug: aspirin and ibuprofen are common first-level treatments for the first episode, combined with colchicine for at least 3 months; aspirin is the preferred choice in ischaemic heart disease; indomethacin is usually considered for incessant or recurrent cases (ESC 2025, Table 13).[1]
- Kidneys: full-dose aspirin or NSAID is recommended with normal or mildly reduced renal function; with moderate to severe renal impairment, dose adjustment or use of corticosteroids is recommended (ESC 2025, Table 13).[1]
- Figure 16 footnote: aspirin is the first option if the patient is already on antiplatelet therapy with aspirin; ibuprofen is usually preferred as the first NSAID; try more than one agent to evaluate response.[1]
Corticosteroids have a narrow place.[1] ESC 2025 says that when aspirin and NSAIDs are contraindicated, or for specific indications, corticosteroids should be considered at low to moderate doses plus colchicine.[1] With an incomplete response to aspirin or NSAIDs and colchicine, corticosteroids may be added at low to moderate doses as triple therapy.[1] ESC 2025 names omission of colchicine and high-dose corticosteroids with fast tapering as risk factors for recurrences or a chronic course.[1]
Rest is part of the treatment.[1] ESC 2025 describes restriction of physical activity beyond sedentary activities until symptom resolution and clinical remission with normalisation of inflammatory markers, and says at least 1 month is needed to reach clinical remission, but it can last longer.[1] ESC 2025: restriction of physical exercise until remission, for at least 1 month, is recommended in athletes and non-athletes after IMPS using an individualised approach to accelerate recovery (Class I, Level C).[1]
Monitoring is mostly clinical.[1] ESC 2025 says monitoring of serum CRP and CMR imaging is recommended to assess clinical remission, guide treatment length and evaluate response in more complicated and difficult-to-treat cases, and that in uncomplicated cases clinical follow-up with or without echocardiography is sufficient.[1]
[1]The colchicine evidence
The colchicine row, first-line therapy as an adjunct to aspirin/NSAID or corticosteroid therapy to reduce subsequent recurrences, carries Class I, Level A.[1] ESC 2025 says the use of colchicine on top of empirical anti-inflammatory therapy is supported by most of the published evidence, with the single exception of a small open-label trial that was probably underpowered for patients with acute pericarditis.[1]
Prospective, randomised, open-label; conventional treatment with aspirin, or the same plus colchicine 1.0 to 2.0 mg for the first day and then 0.5 to 1.0 mg/d for 3 months
Population: 120 patients with a first episode of acute pericarditis (idiopathic, viral, postpericardiotomy syndromes and connective tissue diseases)
Key finding
Over 2873 patient-months of follow-up, recurrence at 18 months 10.7% versus 32.3% (P=0.004; number needed to treat 5); symptom persistence at 72 hours 11.7% versus 36.7%
Practice change
Corticosteroid use was an independent risk factor for recurrence (OR 4.30); colchicine was stopped in 5 cases (8.3%) for diarrhoea, with no serious adverse effects
Multicentre, double-blind, placebo-controlled; colchicine 0.5 mg twice daily for 3 months (>70 kg) or 0.5 mg once daily (≤70 kg), added to aspirin or ibuprofen; primary outcome incessant or recurrent pericarditis
Population: 240 adults with acute pericarditis, 120 in each group
Key finding
Primary outcome 16.7% with colchicine versus 37.5% with placebo (relative risk reduction 0.56; number needed to treat 4; P<0.001); less symptom persistence at 72 hours and a higher remission rate at 1 week
Practice change
Overall adverse effects and study-drug discontinuation were similar in the two groups
Incessant and recurrent pericarditis
Recurrence is the commonest complication.[1] ESC 2025 calls recurrence the most common and problematic complication of acute pericarditis, affecting 20%–30% of patients not treated with colchicine.[1] In its section on incessant and recurrent pericarditis it gives 15% to 30% after a first episode, usually within 18 months of the index episode.[1] It may rise to 50% after a first recurrence in patients whose first episode was inadequately treated, for example by too-fast tapering, no colchicine, or treatment with corticosteroids.[1]
In incessant or recurrent pericarditis, colchicine is always part of the mainstay of therapy.[1] ESC 2025 says that in incessant or recurrent pericarditis the mainstay of therapy is always colchicine with aspirin or an NSAID, or with low to moderate doses of corticosteroids.[1] For more difficult cases, chest pain can be controlled with aspirin or an NSAID plus low- to moderate-dose corticosteroids and colchicine (triple therapy).[1] A patient who recurs during corticosteroid tapering should continue colchicine and receive an NSAID on top, instead of an increased corticosteroid dose.[1]
- Colchicine duration: ESC 2025 Figure 16 says to consider at least 3 months for the first episode and at least 6 months for incessant or recurrent cases, and to withdraw colchicine as the last drug only after stable remission.[1]
- Slower tapering: treatment with aspirin, NSAIDs and steroids should be extended in an individualised way, with slower tapering than for a first episode (ESC 2025).[1]
- Steroid tapering: every decrease in prednisone should be made only if the patient is asymptomatic and CRP is normal, particularly for doses below 25 mg/day; tapering is particularly slow below 15 mg/day, the common threshold for recurrences (ESC 2025, Tables 13 and 14).[1]
- Bone protection: calcium 1200–1500 mg/day (supplement plus oral intake) and vitamin D 800–1000 IU/day should be offered to all patients receiving glucocorticoids (ESC 2025).[1]
Tapering of corticosteroids (ESC 2025, Table 14)
| Prednisone daily dose | Tapering (ESC 2025, Table 14) |
|---|---|
| >50 mg | 10 mg/day every 1–2 weeks |
| 50–25 mg | 5–10 mg/day every 1–2 weeks |
| 25–15 mg | 2.5 mg/day every 2–4 weeks |
| <15 mg | 1.25–2.5 mg/day every 2–6 weeks |
The Table 14 footnote says to avoid higher doses except in special cases, and then only for a few days with rapid tapering to 25 mg/day; prednisone 25 mg is equivalent to methylprednisolone 20 mg.[1]
When standard therapy fails
Rows for refractory disease (ESC 2025, Recommendation Table 10; selected rows)
| ESC 2025 recommendation (Recommendation Table 10) | Class | Level |
|---|---|---|
| Anti-IL-1 agents (anakinra or rilonacept) for recurrent pericarditis after failure of first-line therapies and corticosteroids and elevation of CRP levels, to reduce recurrences and allow corticosteroid withdrawal | I | A |
| Anti-IL-1 agents (anakinra or rilonacept) should be considered in incessant or recurrent pericarditis with evidence of pericardial inflammation on CMR after failure, contraindications and intolerance to first-line therapies and corticosteroids, regardless of CRP levels, to reduce recurrences and allow corticosteroid withdrawal | IIa | C |
| Hydroxychloroquine may be considered in recurrent pericarditis refractory to standard therapy (including corticosteroids and anti-IL-1 agents), to prolong recurrence-free survival | IIb | B |
- Why anti-IL-1: ESC 2025 cites the rapid onset of action and the possibility of rapid withdrawal of corticosteroids, and says these agents may be associated with a moderate increase in the overall risk of mild to moderate infections.[1]
- Anakinra dose: 1–2 mg/kg/day up to 100 mg/day in adults, for at least 6 months, with tapering needed (at least 3–6 months) (ESC 2025, Table 13).[1]
- Rilonacept availability: registered in the USA but not currently available in Europe; anakinra, with its short half-life, may be the preferable choice in patients at increased risk of infections (ESC 2025, Table 13).[1]
- Azathioprine: ESC 2025 says it seems more appropriate as a steroid-sparing agent and has limited efficacy for acute pain.[1]
- Intravenous immunoglobulins: tested in refractory recurrent pericarditis after failure of first and second options, as well as anti-IL-1 agents (ESC 2025).[1]
- Hydroxychloroquine: has shown a steroid-sparing effect and increased flare-free survival in recurrent pericarditis with colchicine resistance and corticosteroid dependence (ESC 2025).[1]
Prospective, randomised, double-blind, placebo-controlled, multicentre; colchicine 1.0 to 2.0 mg on the first day then 0.5 to 1.0 mg/d for 6 months, or placebo, added to conventional treatment
Population: 120 patients with a first recurrence of pericarditis at 4 general hospitals in Italy; multiple recurrences and neoplastic or bacterial causes were excluded
Key finding
Recurrence at 18 months 24% with colchicine versus 55% with placebo (absolute risk reduction 0.31; relative risk reduction 0.56; number needed to treat 3)
Multicentre, double-blind, at four general hospitals in northern Italy; colchicine 0.5 mg twice daily for 6 months (>70 kg) or once daily (≤70 kg), or placebo, added to aspirin, ibuprofen or indometacin
Population: Adults with multiple (two or more) recurrences of pericarditis
Key finding
Recurrent pericarditis in 21.6% (26 of 120) with colchicine versus 42.5% (51 of 120) with placebo (relative risk 0.49; number needed to treat 5); no serious adverse events reported
Double-blind, placebo-controlled, randomised withdrawal trial at 3 Italian referral centres; open-label anakinra 2 mg/kg per day, up to 100 mg, for 2 months, then responders randomised to continue anakinra or switch to placebo for 6 months or until recurrence
Population: 21 patients with recurrent pericarditis (3 or more previous recurrences), elevated CRP, colchicine resistance and corticosteroid dependence
Key finding
Recurrence in 9 of 10 patients (90%) on placebo versus 2 of 11 (18.2%) on anakinra
Practice change
The investigators call it a preliminary study and say larger studies are needed for safety and longer-term efficacy
Phase 3, multicentre, double-blind, event-driven, randomised-withdrawal; a 12-week run-in on rilonacept with background medications stopped, then responders randomised 1:1 to rilonacept monotherapy or placebo subcutaneously once weekly
Population: Patients with acute symptoms of recurrent pericarditis and an elevated CRP level, presenting with a recurrence while on standard therapy; 86 entered the run-in and 61 were randomised
Key finding
Recurrence in 2 of 30 (7%) on rilonacept versus 23 of 31 (74%) on placebo (hazard ratio 0.04); median time to pain resolution or near-resolution 5 days and to CRP normalisation 7 days during the run-in
Practice change
Most common adverse events with rilonacept: injection-site reactions and upper respiratory tract infections
ESC 2025 says a course with multiple recurrences is possible but not usual in simple presumed viral pericarditis, and should prompt a search for an underlying cause.[1] ESC 2025: long-term follow-up is recommended for patients with incessant or recurrent pericarditis to identify a potential progression and new complications (Class I, Level C).[1]
Pericarditis after myocardial infarction and cardiac surgery
ESC 2025 groups these under post-cardiac injury syndrome (PCIS), an umbrella term for a group of inflammatory pericardial syndromes, including late post-acute MI pericarditis (Dressler syndrome), post-pericardiotomy syndrome (PPS) and post-traumatic pericarditis with or without bleeding.[1] It says these syndromes are presumed to have an autoimmune pathogenesis triggered by pericardial bleeding and/or pleural incision, and that an immune-mediated pathogenesis is supported by a latent period (generally a few weeks), the positive response to anti-inflammatory drugs and the possibility of recurrences.[1] The same therapeutic scheme adopted for acute pericarditis, essentially based on empirical anti-inflammatory therapy, is effective for all forms of PCIS and may improve remission rates and reduce the risk of recurrences (ESC 2025).[1]
Post-cardiac injury syndrome rows (ESC 2025, Recommendation Table 22)
| ESC 2025 recommendation (Recommendation Table 22) | Class | Level |
|---|---|---|
| Anti-inflammatory therapy in PCIS to hasten symptom remission and reduce recurrences | I | B |
| IL-1 antagonists in refractory PCIS to prevent recurrences and progression to constriction | I | B |
| High-dose aspirin as the first-choice anti-inflammatory therapy for post-myocardial infarction pericarditis and in patients already on antiplatelet therapy | I | C |
| Colchicine, started 48 to 72 h before cardiac surgery, should be considered for 1 month after cardiac surgery for the prevention of PCIS if there are no contraindications and if it is tolerated | IIa | A |
| Careful follow-up should be considered in PCIS to exclude possible evolution towards constrictive pericarditis | IIa | C |
After myocardial infarction
The 2023 ESC ACS guideline separates early infarct-associated pericarditis (from a few hours to 4 days after acute MI, mostly transient) from late pericarditis or post-cardiac injury (Dressler) syndrome (typically 1–2 weeks after acute MI).[3] ESC 2025 says Dressler syndrome now appears in under 1% of cases, mainly in larger infarctions and/or late reperfusion, typically 1–2 weeks after acute MI.[1] It adds that a post-MI pericardial effusion of more than 10 mm at end-diastole should be investigated for a possible subacute heart rupture.[1]
Post-MI pericarditis: what each body says
| Statement | Class / level |
|---|---|
| ESC 2025: in early post-MI pericarditis, a 5–7-day course of aspirin seems the most reasonable option, with colchicine | (no class or level given) |
| ACC/AHA 2025 ACS: early pericarditis typically arises 1 to 3 days after a transmural event, is typically transient and resolves with conservative therapy; acetaminophen can be given for symptomatic relief | (no class or level given) |
| ACC/AHA 2025 ACS: if symptoms persist despite standard supportive therapy in early pericarditis, and in any late pericarditis, high-dose aspirin may be used to reduce symptoms; colchicine should also be considered to reduce symptoms and decrease the risk of recurrence | (no class or level given) |
| ACC/AHA 2025 ACS: glucocorticoids and NSAIDs (other than aspirin) are potentially harmful because of a possible increase in the risk of recurrent MI or impaired myocardial healing and risk of rupture | (no class or level given) |
The ACC/AHA 2025 ACS guideline puts post-MI pericarditis at 0.1%–0.5% in the era of early coronary reperfusion, and notes that dedicated randomised trials of high-dose aspirin are lacking.[4] Its Table 18 (clinical criteria for diagnosis of pericarditis) requires pleuritic chest pain and at least one of three criteria.[4] These are a friction rub; electrocardiographic evidence such as classic PR-segment depression or diffusive concave ST-segment elevations or, in the setting of MI, persistent ST-segment elevations or dynamic T-wave changes; or a new or growing pericardial effusion on echocardiography.[4] Its Table 19 (additional therapy for persistent or late pericarditis symptoms) gives high-dose aspirin 500–1000 mg every 6–8 h until symptoms improve, and colchicine 0.5–0.6 mg once or twice daily for 3 months.[4] Its footnote says daily dosing should be used in patients who weigh under 70 kg, further adjusted in stage 4–5 kidney disease, severe hepatic impairment, or with concomitant P-glycoprotein and/or moderate and severe CYP3A4 inhibitors.[4]
Both early post-MI pericarditis and Dressler syndrome are markers of larger infarct size, without independent prognostic significance (ESC 2025).[1] See also STEMI: reperfusion.
After cardiac surgery and other procedures
ESC 2025 says the diagnosis of PCIS may be reached with at least two of five proposed criteria: fever without alternative causes; pericardial or pleuritic chest pain; pericardial or pleural rubs; evidence of pericardial effusion; and/or pleural effusion with elevated CRP.[1] It calls the demonstration of inflammatory activity, such as CRP elevation, essential to establish the diagnosis.[1] Cases after device implantation or arrhythmia ablation are becoming increasingly common; pericarditis appears in about 10% of cases after AF ablation.[1]
- Prevention evidence: ESC 2025 reports a meta-analysis's finding that, of the strategies tried for primary prevention of PPS (aspirin, methylprednisolone, dexamethasone and colchicine), only colchicine was associated with a decreased risk (OR 0.38), sometimes with an increased risk of gastrointestinal side effects.[1]
- Text dose: ESC 2025 says preventive colchicine can be given after cardiac surgery using weight-adjusted doses (0.5 mg once for patients ≤70 kg and 0.5 mg twice daily for patients >70 kg), without a loading dose, and continued for 1 month.[1]
- Effusions alone: neither NSAIDs nor colchicine have to be given for post-operative effusions in the absence of systemic inflammation (ESC 2025).[1]
- Outlook: in the largest published PPS series after cardiac surgery, complication rates were low: under 4% recurrences, under 2% tamponade and no constriction, although hospital stay may be prolonged (ESC 2025).[1]
Multicentre, double-blind, randomised; on the third post-operative day, placebo or colchicine 1.0 mg twice daily for the first day then 0.5 mg twice daily for 1 month (≥70 kg), with halved doses below 70 kg or if the higher dose was not tolerated
Population: 360 patients after cardiac surgery, 180 in each arm
Key finding
PPS at 12 months 8.9% with colchicine versus 21.1% with placebo (P = 0.002; number needed to treat 8)
Investigator-initiated, double-blind, placebo-controlled, randomised, in 11 Italian centres (2012–2014); colchicine 0.5 mg twice daily (≥70 kg) or once daily (<70 kg), started 48 to 72 hours before surgery and continued for 1 month after
Population: 360 consecutive candidates for cardiac surgery
Key finding
Primary end point of postpericardiotomy syndrome in 19.4% with colchicine versus 29.4% with placebo (number needed to treat 10)
Practice change
No reduction in postoperative AF or pericardial or pleural effusion; more gastrointestinal adverse effects reduced the potential benefit
Myopericarditis
ESC 2025 says myopericarditis can be clinically established when patients with definite criteria for acute pericarditis show elevated biomarkers of myocardial injury, without newly developed focal or diffuse impairment of LV function on transthoracic echocardiography or CMR.[1] At present, patients with myopericarditis can be treated as patients with pericarditis, while those with perimyocarditis should be managed as patients with pure myocarditis.[1]
Complications and pitfalls
- Tamponade and constriction: ESC 2025 calls them the two most serious complications; both are relatively rare in acute pericarditis (under 1% of cases).[1]
- Risk depends on cause: ESC 2025 puts the risk of constrictive pericarditis as low after presumed viral or idiopathic pericarditis, intermediate (2%–5%) for immune-mediated aetiologies, PCIS and neoplastic pericarditis, and high (20%–30%) for bacterial pericarditis, especially if purulent.[1]
- Incessant course: about 10% of patients may present with continued symptoms without clinical remission; these incessant cases may progress directly to constriction within a few months, whereas constriction is extremely rare in idiopathic recurrent pericarditis (ESC 2025).[1]
- Transient constriction: ESC 2025 says it develops in pericarditis with or without effusion in about 10% of cases and resolves with anti-inflammatory therapy in more than 50%.[1]
- Steroid trap: in COPE (first episode of acute pericarditis), corticosteroid use was an independent risk factor for recurrence (OR 4.30); ESC 2025 says every effort should be made not to increase the dose or to reinstate corticosteroids in a recurrence.[6][1]
For pericardiocentesis and tamponade management, see Cardiac tamponade. ESC 2025: pericardiocentesis (echocardiography-, CT- or fluoroscopy-guided) is recommended for cardiac tamponade, suspected bacterial or neoplastic pericarditis, or symptomatic moderate to large pericardial effusion despite medical therapy (Class I, Level C).[1]
Prognosis and follow-up
ESC 2025 says the usual course of acute pericarditis is clinical remission after medical therapy within 4–6 weeks.[1] The in-hospital mortality rate for acute pericarditis is around 1% on average, but can be higher in older patients and those with severe co-infections.[1] Chronic pericarditis significantly impairs quality of life, but ESC 2025 says its rate of progression to constriction is negligible (under 1%) and lower than the risk imposed by a single episode, unless a specific aetiology is identified.[1]
ESC 2025 defines clinical remission as full regression of symptoms with normalisation of laboratory results (such as CRP and troponin) and investigations (ECG, evidence of pericardial effusion, CMR evidence of active inflammation).[1] It recommends an individualised return to activity based on remission times, and says complete clinical remission should be considered in athletes and non-athletes with normalisation of symptoms, biomarkers and imaging.[1]
Several proposed risk scores exist, but ESC 2025 says they have not been validated or replicated in larger studies and remain investigational.[1]
Special populations
Pregnancy and lactation
ESC 2025 says pericardial effusion is the most common manifestation of pericardial disease in pregnancy and acute pericarditis is the second most common.[1] High-dose aspirin or NSAIDs such as ibuprofen and indomethacin can be used up to the 20th week of gestation.[1] Colchicine is compatible with pregnancy and breastfeeding and can be continued throughout pregnancy to prevent recurrences; ESC 2025 says all the drugs it lists for pregnancy, apart from high-dose aspirin, may be used during lactation.[1] ESC 2025 also says NSAIDs should be considered in pregnant patients with pericarditis until the 20th week to treat an incessant or recurrent course (Class IIa).[1]
Pregnancy, lactation and reproductive issues (ESC 2025, Recommendation Table 25; pericarditis rows)
| ESC 2025 recommendation (Recommendation Table 25) | Class | Level |
|---|---|---|
| Pre-conception counselling in women with recurrent pericarditis or myocarditis, to assess disease activity and review therapy | I | C |
| During pregnancy and breastfeeding, corticosteroids at the minimal effective dose (preferably up to 20 mg prednisone daily) should be considered in active pericarditis, despite NSAID (if feasible), to prevent an incessant or recurrent course | IIa | C |
| Anti-inflammatory therapies should be considered in patients with pericarditis during lactation to treat and prevent pericarditis, with timing adjusted to reduce drug exposure of the breastfed infant | IIa | C |
| Colchicine may be considered in pregnant patients with pericarditis, especially those already receiving it, to prevent recurrences | IIb | C |
| Anakinra may be considered through pregnancy and lactation in recurrent pericarditis when alternative therapies cannot be used, to prevent an incessant or recurrent course | IIb | C |
Children
- ESC 2025 reports an incidence of 2.8 per 100 000 in children aged 12 years or less, in a population study from 2009 to 2021.[1]
- Most paediatric cases are related to PPS, particularly after atrial septal defect closure (ESC 2025).[1]
- NSAIDs remain the mainstay at high dosages and most paediatricians avoid aspirin; colchicine halved recurrences in children, as in adults (ESC 2025).[1]
- Corticosteroids should be restricted even more than in adults, because side effects such as striae rubrae and growth impairment are particularly deleterious in growing children (ESC 2025).[1]
Older patients and kidney disease
ESC 2025 reports that elderly patients less often had chest pain, fever, ST elevation and PR depression, had lower CRP values, and more often had dyspnoea, AF and pericardial effusion.[1] They received glucocorticoids more often and had a lower risk of recurrence than younger patients.[1] ESC 2025 says NSAIDs should be used cautiously in older patients, with adapted dosing (for example, colchicine halved in some cases) and attention to renal impairment and drug interactions.[1] Table 13 gives colchicine 0.5 mg once daily below 70 kg or with severe renal impairment.[1]
Evidence, guidelines and regional differences
Compared with its 2015 pericardial guideline, ESC 2025 reports an improved understanding of the role of autoinflammation, genetic background and immune responses in patients with multiple recurrences.[1] It describes anti-IL-1 agents as a new class of drugs used in recurrent cases with a poor response to other conventional therapies.[1]
ESC 2025
myocarditis and pericarditis guideline
- Definite pericarditis: clinical presentation plus more than one additional criterion (Table 4)
- Colchicine as a first-line adjunct to aspirin/NSAID or corticosteroids to reduce subsequent recurrences (Class I, Level A)
- High-dose aspirin as first-choice anti-inflammatory therapy for post-myocardial infarction pericarditis and in patients already on antiplatelet therapy (Class I, Level C)
ACC/AHA 2025 ACS guideline
post-MI pericarditis section
- Post-MI pericarditis diagnosed with pleuritic chest pain and at least one further criterion (Table 18)
- High-dose aspirin may be used to reduce symptoms if symptoms persist despite standard supportive therapy in early pericarditis, and in any late pericarditis; colchicine should also be considered to reduce symptoms and decrease risk of recurrence (no class or level given)
- Glucocorticoids and NSAIDs other than aspirin are potentially harmful after MI (no class or level given)
ANZ practice
No NHFA/CSANZ guideline on pericarditis was found in the census of PubMed and the guideline register for this topic, so the ESC 2025 rows are the guideline layer used here. Australian data come from New South Wales: a retrospective observational study of patients hospitalised with pericardial disease in all public and private hospitals in the state from 2004 to 2021.[14]
- Of 45 446 patients with pericardial disease, under half (46.8%) had it as the primary reason for hospitalisation; these patients were more often male (68.2% vs 59.1%), younger (median 51.2 vs 66.0 years) and less comorbid than those with a secondary diagnosis.[14]
- The investigators conclude that in-hospital mortality is low, about 1%, when pericardial disease is the primary diagnosis, but much worse when it is a secondary diagnosis, especially with comorbidities such as malignancy.[14]
- In a retrospective cohort of all hospitalised patients with pericardial disease from 2004 to 2021 in the New South Wales Admitted Patient Data Collection database, 763 of 45 445 patients (1.7%) developed constrictive pericarditis; constriction identified during follow-up was more common after hospitalisation for heart failure, nonconstrictive recurrent pericardial disease requiring hospitalisation, or pericardiocentesis.[15]
Gaps in evidence
In its section 16.2, ESC 2025 describes significant knowledge gaps in individualised treatment and in the pathogenesis of the various types of pericarditis, as well as in understanding the interaction among genetic background, inflammation and autoimmune mechanisms.[1] ESC 2025 adds that better knowledge of the pathogenesis of recurrences may also help to develop more targeted and individualised therapies.[1] The genetic background requires further evaluation in complicated, recurrent cases and could be helpful to elucidate the mechanisms leading to incessant or recurrent forms (ESC 2025).[1]
- New drugs: new therapeutic options should also be considered and evaluated in clinical trials to explore new drugs for more complicated, incessant or recurrent cases, to develop a more individualised and efficacious approach to treatment (ESC 2025).[1]
- Non-responders and dependence: ESC 2025 calls the treatment of patients not responding to colchicine and anti-IL-1 agents a significant management issue, as well as the causes of drug dependence to maintain stable clinical remission, such as for corticosteroids and anti-IL-1 agents.[1]
- Pericardial LGE: additional research is also warranted to understand the prognostic significance of persistent LGE of the pericardium (ESC 2025).[1]
- Return to work and physical activity: there are limited data to support the best timing of return to work and physical activity, and further research is needed with appropriate clinical trials or observational studies (ESC 2025).[1]
- Aspirin after MI: the ACC/AHA 2025 ACS guideline says that, given the rarity of post-MI pericarditis, dedicated randomised trials of high-dose aspirin are lacking and data are extrapolated from studies of the heterogeneous diagnosis of acute pericarditis.[4]
Guidelines checked
A row called the current one, or the one covering a group, is so among the guidelines checked for this topic:
- Sources of the rows and statements used: ESC myocarditis and pericarditis (2025), with the 2015 ESC pericardial guideline as history only; ESC acute coronary syndromes (2023); ACC/AHA acute coronary syndromes (2025); the Fifth Universal Definition of MI (2026).[1][2][3][4][5]
- Also swept for same-month or newer rows (the guidelines checked for this topic): ESC/EAS 2025 dyslipidaemia; ESC 2025 pregnancy; ESC/EACTS 2025 valvular disease; ESC 2026 heart failure and cardiac rehabilitation; AHA/ACC 2025 blood pressure and 2026 pulmonary embolism; ACC/AHA 2026 dyslipidaemia; Fifth UDMI 2026.
- Not held as text for this topic: the 2025 ACC concise clinical guidance (an expert consensus statement) on the diagnosis and management of pericarditis.
Exam pearls
- Definite pericarditis (ESC 2025): clinical presentation plus more than one additional criterion; one criterion makes it possible (Table 4).[1]
- The 2015 ESC rule, now history, was two of four criteria.[2]
- The pericardium is electrically silent: ECG changes imply myocardial involvement (ESC 2025).[1]
- High-risk features (ESC 2025 Table 7) include signs and symptoms of cardiac tamponade, fever above 38 °C, a large effusion over 20 mm at end-diastole, failure of NSAID therapy and incessant pericarditis; hospital admission is recommended for monitoring and treatment (ESC 2025, Class I, Level B).[1]
- Colchicine 0.5 mg twice daily, or 0.5 mg once daily below 70 kg or with severe renal impairment, for 3–6 months; tapering not required (ESC 2025, Table 13).[1]
- Corticosteroids are not recommended as the first option without a specific indication (ESC 2025, Class III, Level C).[1]
- ESC 2025: high-dose aspirin is the first-choice anti-inflammatory therapy for post-myocardial infarction pericarditis and in patients already on antiplatelet therapy (Class I, Level C); the ACC/AHA 2025 ACS guideline calls glucocorticoids and NSAIDs other than aspirin potentially harmful after MI.[1][4]
References15ShowHide
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- [2]Adler Y, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2015.PMID 26320112
- [3]Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J, 2023.PMID 37622654
- [4]Rao SV, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2025.PMID 40014670
- [5]Mills NL, et al. Fifth Universal Definition of Myocardial Infarction (2026): On behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) Affirmation of Value by the Society for Cardiovascular Angiography and Interventions (SCAI). Glob Heart, 2026.PMID 42666939
- [6]Imazio M, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation, 2005.PMID 16186437
- [7]Imazio M, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med, 2013.PMID 23992557
- [8]Imazio M, et al. Colchicine for recurrent pericarditis (CORP): a randomized trial. Ann Intern Med, 2011.PMID 21873705
- [9]Imazio M, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet, 2014.PMID 24694983
- [10]Klein AL, et al. Phase 3 Trial of Interleukin-1 Trap Rilonacept in Recurrent Pericarditis. N Engl J Med, 2021.PMID 33200890
- [11]Brucato A, et al. Effect of Anakinra on Recurrent Pericarditis Among Patients With Colchicine Resistance and Corticosteroid Dependence: The AIRTRIP Randomized Clinical Trial. JAMA, 2016.PMID 27825009
- [12]Imazio M, et al. COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J, 2010.PMID 20805112
- [13]Imazio M, et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA, 2014.PMID 25172965
- [14]Kwan TN, et al. Prognosis of patients hospitalised with primary or secondary pericardial disease: an Australian population-based retrospective cohort study. BMJ Open, 2025.PMID 41407409
- [15]Kwan TN, et al. Epidemiology and Risk Factors for Constrictive Pericarditis in a Statewide Australian Cohort of Patients With Pericardial Disease. Can J Cardiol, 2026.PMID 40983194