Predictors of Long‐Term Survival in Patients With Immune Checkpoint Inhibitor–Associated Myocarditis

• Published in: Journal of the American Heart Association Vol. 14; no. 14; p. e038719
• Main Authors: Dubey, Nikhil, Wu, Chia‐Yun, Zubiri, Leyre, Fay, Magdalena, Rouhani, Sherin J., Merkin, Ross D., Sun, Joie, Locascio, Joseph J., Neilan, Tomas G., Reynolds, Kerry L., Zlotoff, Daniel A.
• Format: Journal Article
• Language: English
• Published: England Wiley 15.07.2025
• Subjects: Aged; Aged, 80 and over; Case-Control Studies; Female; Humans; immune checkpoint inhibitor myocarditis; Immune Checkpoint Inhibitors - adverse effects; immunosuppression; Male; Middle Aged; Myocarditis - chemically induced; Myocarditis - diagnosis; Myocarditis - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate - trends; survivorship; Time Factors; immune checkpoint inhibitor myocarditis; survivorship; immunosuppression
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.038719

Immune checkpoint inhibitor-associated myocarditis (ICIM) carries high rates of morbidity and death, but clinical outcomes vary widely. Little is known about the clinical variables associated with long-term survival. In this case-control study, patients diagnosed with ICIM at Massachusetts General Hospital between 2016 and 2022 were stratified into 3 groups based on length of survival after ICIM diagnosis: short-term (<30 days), intermediate-term (30-365 days), and long-term (>365 days). Baseline characteristics, immune checkpoint inhibitor regimens, laboratory values, ECG parameters, and ICIM treatments were analyzed to identify predictors of long-term survival. Among 35 patients with ICIM (median follow-up time, 8.3 months), there were 9 (25.7%) in the short-term survival group, 13 (37.1%) in the intermediate-term survival group, and 13 (37.1%) in the long-term survival group. Those in the short-term survival group were older (median age, 82 versus 68 for intermediate-term and 75 for long-term; =0.003). Using logistic regression, long-term survival was associated with an interval from immune checkpoint inhibitor initiation to ICIM diagnosis ≥75 days (odds ratio, 5.4; =0.043) and a troponin T decrement ≥42% by day 8 after immunosuppression initiation (odds ratio, 5.5; =0.042). Using multivariate Cox regression modeling, troponin T≤1000 ng/L (hazard ratio [HR], 4.0; =0.007) and neutrophil/lymphocyte ratio ≤4.4 (HR, 7.9;  < 0.001) were independently associated with longer survival. Time to onset of ICIM, multiple clinical tests, and responsiveness to immunosuppressive therapy were associated with long-term survival after ICIM. Consideration of these variables may help with risk stratification and immunosuppressive therapy individualization.