Idiopathic pericarditis in 2025: Advances in diagnosis and therapeutic strategies.

Purulent Pericarditis Caused by Pseudomonas Aeruginosa in an Immunocompetent Child: Is Pericardiocentesis a Must? A Case Report.

Racial and sex differences in acute pericarditis among emergency department chest pain patients: a retrospective cohort study.

Background: Myocarditis is a potentially life-threatening inflammation of the myocardium that can be triggered by viral infections, including influenza. While corticosteroids have historically been used with caution in viral myocarditis due to concerns over impaired viral clearance, recent insights—particularly those emerging from the COVID-19 pandemic—suggest that early, moderate-dose corticosteroid therapy may offer clinical benefits in selected inflammatory cardiac syndromes. This study aimed to assess the incidence and clinical features, as well as short-term outcomes of influenza-related myocarditis and/or pericarditis. Methods: A retrospective, observational study was conducted, including all consecutive patients diagnosed with acute myocarditis and/or pericarditis between December 2024 and March 2025 who presented with chest pain or dyspnea and had a confirmed Influenza A (H1N1) infection. The diagnostic evaluation included cardiac biomarkers, ECG, TTE, and cardiovascular magnetic resonance (CMR). All patients were monitored during a three-month follow-up period. Results: Of 281 patients with laboratory-confirmed H1N1 infection, six (2%) were diagnosed with myocarditis and/or pericarditis. All patients diagnosed with myocarditis received corticosteroid therapy and an antiviral drug (oseltamivir). CMR confirmed the diagnosis in all cases of inflammatory cardiomyopathy. At 30 days, median LVEF improved from 49% to 58%. No deaths or rehospitalizations were reported. Conclusions: Influenza-related myocarditis and/or pericarditis are relatively uncommon, occurring in approximately 2% of cases. When they occur, they are primarily associated with an uncomplicated clinical course and with favourable short-term outcomes, including a rapid recovery of left ventricular function and the absence of adverse events at three-month follow-up.

Electroconvulsive Therapy in a Patient With Schizophrenia and Acute Pericarditis: A Case Report.

BACKGROUND Bacterial purulent pericarditis is rare and can be fatal if not treated appropriately. Streptococcus anginosus can cause invasive and cryptogenic infections, and purulent pericarditis is an uncommon presentation. Alcohol abuse can be a risk factor for abscesses caused by this agent. Cell-free DNA testing is a noninvasive method that has great potential in cases of serious infections in which pathogens are not easily identifiable by traditional microbiological techniques. CASE REPORT A 27-year-old man reported alcohol abuse and was hospitalized for acute pericarditis without signs of severity. He developed cardiac tamponade on the fifth day of hospitalization, requiring emergency pericardiocentesis. A significant persistent pericardial effusion was observed. Videopericardiectomy revealed a large amount of fibrin and purulent secretion in the pericardial sac. Additional tests and cultures did not identify systemic disease or an etiological agent. A cell-free DNA assay identified S. anginosus. He was discharged after 4 weeks of broad-spectrum antimicrobial therapy. There was no progression to constrictive pericarditis. CONCLUSIONS We present a case of purulent bacterial pericarditis with a cryptogenic focus in a young adult patient with a history of alcohol, marijuana, and e-cigarette abuse. He developed cardiac tamponade but received rapid and appropriate in-hospital therapeutic support, with clinical recovery within a few weeks. Alcohol and smoking may have facilitated bacterial translocation from the oropharynx to the bloodstream and then to the pericardium. S. anginosus was identified only by molecular research.

Part 2 of this series on pericarditis focuses on the inflammatory phenotype of acute and recurrent pericarditis. The paper presents clinical, laboratory, and imaging features characteristic of the inflammatory phenotype, along with current diagnostic and therapeutic approaches. The stages of diagnostic evaluation are described in detail — from confirming pericarditis and ruling out myocarditis to targeted identification of infectious, autoimmune, autoinflammatory, and neoplastic causes. Data are provided on risk factors and mechanisms of infectious and bacterial pericarditis, as well as on specific aspects of pericardial fluid analy­sis. Current reference values for pericardial fluid and the diagnostic significance of various laboratory parameters are discussed. The article also reviews the use of invasive diagnostic methods, including pericardiocentesis and pericardial biopsy, and outlines the principles of anti-inflammatory therapy with nonsteroidal anti-inflammatory drugs, colchicine, glucocorticoids, and interleukin-1 blockers. A practice-­oriented algorithm for managing patients with acute pericarditis of the inflammatory phenotype is proposed, integrating cardiological, rheumatological, and immunological perspectives.

Introduction . Idiopathic recurrent pericarditis (IRP) is a rare inflammatory disease that manifests with acute pericarditis, followed by an asymptomatic period of 4-6 weeks or more, after which the disease relapses. The etiology of pericarditis cannot be determined in the vast majority of cases. Unfortunately, in real-world practice, physicians have no apprehensive attitude to IRP and patients with acute pericarditis are not followed up. Consequently, IRP is often diagnosed late, as demonstrated by the presented case. Brief description . We describe a case of a 49-year-old female patient with recurrent pericarditis of unknown etiology, associated with arthralgia and skin manifestations. The first episode was characterized by pericardial effusion, elevated erythrocyte sedimentation rate and C-reactive protein, and resistance to nonsteroidal anti-inflammatory drugs. Remission was achieved with colchicine therapy, but it relapsed after 5 months and was treated with glucocorticoids. Conclusion . This case of IRP shows the complexities of differential diagnosis and demonstrates the importance of timely treatment.

Introduction: Purulent pericarditis is a subtype of acute pericarditis with a high mortality even when adequately treated. Standard therapy is a combination of antibiotics and drainage, which can be more or less invasive. This is a case report of a patient with purulent pericarditis where cardiac surgery via sternotomy for thorough debridement and lavage was required for complete infection control Case presentation: A 41-year-old man with a history of injected and inhaled drug use was admitted with a large pericardial effusion, and 700 mL of pus was percutaneously drained. After being started on broad spectrum antibiotics the patient remained with persistent signs of infection, and was submitted to surgical drainage and debridement via full median sternotomy. The patient improved progressively afterwards, and after agent identification and being started on intravenous penicillin, he was discharged after 4 weeks, without evidence of wound infection Clinical Discussion: An organized pleural effusion was likely the cause of the purulent pericarditis. Of all invasive treatment options available, full median sternotomy was considered the most appropriate for this patient, as it allowed for maximal exposure for debridement. Even though the patient was operated in an actively infected state, there was no wound infection or dehiscence, in part because of meticulous perioperative wound care Conclusion: Purulent pericarditis is a fatal disease, and cardiac surgery via full median sternotomy may be necessary and at times the most appropriate for adequate complete treatment, as it is simple, easily reproducible, and with an acceptable risk of wound infection

A case of thyrotoxicosis-induced pericarditis and pleuritis is presented, detailing the potential pitfalls of diagnosis and therapy. The authors wish to draw attention to the fact that this thyroid disease should also be considered in cases of acute pericarditis, so that cause-related treatment can be initiated as soon as possible. Orv Hetil. 2026; 167(1): 37-40.

Pericardial disease can present clinically as acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis (CP). Pericardial calcification is present in less than 25% of all cases of CP, and patients with this finding are at risk for developing additional cardiac complications. A case of extensive pericardial ossification in a 65‐year‐old male presenting with pericardial effusion is reported. The patient had several episodes of pericardial effusion and was diagnosed with CP and subsequently managed on medical therapy. Due to worsening symptoms, additional investigations were completed, including echocardiogram, which revealed diastolic dysfunction with constrictive physiology. He underwent bilateral anterior pericardiectomy, and during the surgery, thickened, calcified, and adherent pericardium was identified, along with pockets of effusion. Cytology of pericardial fluid was negative for malignant cells. Histologic sections of the pericardium demonstrated extensive pericardial ossification with widespread bone formation in pericardial/epicardial adipose tissue. Idiopathic pericardial ossification, as identified in our case, is a rare phenomenon only described several times in the literature and may cause CP. Early intervention with pericardiectomy is a predictor of good outcome in CP, and thus, it is important to include rare entities such as metaplastic ossification in the differential for pericardial disease, to facilitate prompt diagnosis and surgical intervention.

Introduction. Combined aortic and mitral valve lesions on the background of coronary artery disease require complex surgical correction and are associated with high perioperative risk and frequent complications. Local data on such interventions remain limited. Aim. To determine the structure of complications following combined aortic and mitral valve replacement with concomitant coronary artery bypass grafting (AVR+MVR+CABG). Materials and Methods. A retrospective single-center study included 57 patients operated in 2018-2023. Clinical, laboratory, and echocardiographic parameters were analyzed; operative risk was assessed using EuroSCORE II and STS models. Intra- and postoperative parameters were recorded; complications were classified as acute kidney injury (AKI, KDIGO), bleeding (BARC≥3), infectious, neurological, cardiac, pericarditis, rethoracotomy, and in-hospital mortality. Uni- and multivariate logistic regression was used to identify predictors of the composite endpoint (mortality / major complications) with ORs and 95 % CI (p<0.05). Results and discussion. Patients were high-risk: EuroSCORE II Me 7.0 % [4.3-10.9], STS mortality 12.2 % [8.7-17.3], STS mortality/morbidity 61.3 % [49.9-69.0]. In-hospital mortality was 10.5 % (6/57). The main causes of death were acute kidney injury progressing to multiorgan failure (n=2), acute cerebrovascular accident (n=1), pneumonia with septic shock (n=1), mediastinitis with sepsis (n=1), and acute graft thrombosis resulting in myocardial infarction (n=1). Major postoperative complications included: AKI 38.0 % (dialysis-dependent 15.8 %), infectious complications 47.4 % (mediastinitis 7.0 %), neurological disorders 43.9 % (delirium/encephalopathy), stroke 7.0 %, rethoracotomy for bleeding 12.3 %, and pericarditis 10.5 %. Typical hyperlactatemia peaked at 6 hours and normalized within 48 hours. Postoperative valve gradients remained within expected ranges; left ventricular ejection fraction at discharge was Me 50 % [41-56]. Preventive priorities include KDIGO-based AKI prevention, neuroprotection and delirium/stroke prevention strategies, strengthened infection control, blood conservation programs, and refined perioperative risk stratification. Conclusions. The combined valve–coronary cohort demonstrated high surgical risk, with elevated EuroSCORE II and STS indices and hospital mortality of 10.5 %. Functional results were satisfactory: prosthetic valve gradients remained within expected limits, and LVEF at discharge (Me 50 % [41-56]) indicated stable systolic performance. The postoperative course was dominated by an organ-dysfunction–driven complication structure, including renal complications (AKI 38.0 %, dialysis-dependent 15.8 %), infectious events (47.4 %, mediastinitis 7 %), neurological disorders (delirium/encephalopathy 43.9 %, stroke 7 %), and additional cardiac/bleeding complications (re-thoracotomy 12.3 %, pericarditis 10.5 %). The findings support the need for standardized perioperative pathways, emphasizing KDIGO-based renal protection, neuroprotection, infection control, and blood-conservation strategies, with combined EuroSCORE II+STS use for precise risk stratification.

Prognostic Value of NT-proBNP in Patients Treated With Allogeneic Stem Cell Transplantation

Abstract Takotsubo cardiomyopathy is defined as a reversible non-ischemic regional wall motion abnormality. A 68-year-old female presented with an acute onset of breathlessness and chest pain for one day. The electrocardiogram showed features suggestive of acute pericarditis. Her troponin I was elevated. Echocardiographic evaluation revealed a regional wall motion abnormality in the apex. Upon proceeding to an emergency invasive coronary angiography, the proximal left anterior descending artery was found to have a left dominant system with non-flow-limiting coronary artery disease. Takotsubo cardiomyopathy-like characteristics were seen on the left ventricular angiography. Colchicine and high-dose aspirin were prescribed to her. After 24 hours, an electrocardiogram revealed a drop in ST elevation. Acute pericarditis can be associated with takotsubo cardiomyopathy, either as a cause or an effect.

Inflammatory biomarkers are increasingly recognized as key tools in diagnosing, stratifying risk, and monitoring treatment in pericarditis, though their value is limited by non-specificity, variability, and treatment interactions. This narrative review integrates current evidence and recommendations from recent studies, as well as the 2025 ESC and ACC guidelines, focusing on conventional and emerging biomarkers across acute, recurrent, and chronic pericarditis. C-reactive protein remains the most practical biomarker for diagnosis and therapeutic monitoring, with persistent elevation linked to recurrence. Troponin identifies myocardial involvement, guiding follow-up but not adversely affecting outcomes in idiopathic cases. Erythrocyte sedimentation rate and white blood cell count add supportive yet nonspecific information. Exploratory markers - such as interleukins, soluble urokinase plasminogen activator receptor, microRNAs, and hematologic indices - show potential for refined risk prediction but remain investigational due to limited access and a lack of standardization. Imaging, particularly cardiac magnetic resonance, complements biomarker data and is particularly crucial in cases where biomarkers are negative. Biomarkers are central yet imperfect components of pericarditis management. Their future utility will rely on integration with imaging, composite marker panels, and artificial intelligence-based analytics, promoting precision medicine while current practice remains grounded in combined clinical, laboratory, and imaging assessment.

IntroductionCoronavirus disease (COVID-19) increases the risk of cardiovascular complications, and artificial intelligence (AI) offers promising tools for early risk prediction.ObjectiveTo develop AI models capable of identifying predictors of cardiovascular events in hospitalized COVID-19 patients.MethodologyRetrospective multicentre cohort, which included adult COVID-19 patients from 25 hospitals (March/2021–August/2022). Cardiovascular outcomes, inluding arrhythmia, acute heart failure, myocardial infarction, myocarditis, and pericarditis, were combined into a composite outcome. Two predictive models were developed using the Light gradient-boosting machine (LightGBM): model 1 used 59 variables (demographic, clinical, laboratory, and socioeconomic data) while model 2 used 52 variables (excluding socioeconomic factors). Model performance was assessed using accuracy, macro-F1, recall, precision, and area under the receiving operating characteristic curve (AUROC). Shapley additive explanation (SHAP) values identified the most influencial predictors. To address class imbalance, we applied random oversampling.ResultsAmong 10,700 patients (median age 59 years [interquatile range 48–70]), 5.3% experienced the composite outcome. Both models showed moderate discrimination (AUROC: 0.752 and 0.760) and high accuracy (94.6% and 94.5%). However, class imbalance resulted in low macro-F1 scores (51.2% and 50.7%). F1 scores were high for the majority class (non-events: 97.2%) but very low for the minority class (cardiovascular events: 5.2% and 4.2%). Even after oversampling, performance for the minority class remained limited, with a maximum F1 score of 21.5%, primarily driven by gains in recall. SHAP analysis identified age, urea, platelet count, and oxygen saturation/inspired oxygen fraction (SatO2/FiO2) as key predictors.ConclusionDespite moderate AUROC and high accuracy, both AI models demonstrated limited ability to detect cardiovascular events due to class imbalance. The persistently low F1 score for the minority class underscores this limitation. Traditional rebalancing techniques produced only small gains, mostly improving recall occurring at the expense of precision. Age, urea levels, platelet count, and SatO2/FiO2 were identified as the most relevant predictors of cardiovascular complications in this cohort.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-025-11465-6.

Abstract Background Cardiac Magnetic Resonance(CMR) is gaining importance for diagnosis and prognosis stratification of pericarditis, and may help guide therapy especially in case of refractory symptoms. Data on quantitative evaluation of pericardial inflammation with CMR, including LGE and mapping techniques, are currently limited. Purpose to assess the utility of tissue characterization of pericardium with quantitative evaluation methods in outcome prediction of acute or recurrent pericarditis. Materials and Methods consecutive patients hospitalized or referred to our centre to perform CMR with a diagnosis of acute or recurrent pericarditis were enrolled. CMR performed within one month from diagnosis of acute/recurrent pericarditis and clinical follow up of at least 6 months were the inclusion criteria. In the postprocessing analysis of CMR images, quantitative evaluation of oedema and LGE amount on pericardium with different techniques [i.e. 5 and 6 standard deviation (SD) and full width half maximum (FWHM) methods on inversion recovery (IR) and T2weighted (T2w) sequences] and T1 and T2 maximum values measurement on inflamed pericardium with mapping were performed. Univariate/multivariate Cox regressions were performed to investigate the potential association between the different CMR quantitative parameters and the occurrence of recurrence; the propensity score based on clinical significant variables (age, gender, C-reactive protein values and therapy) was used as adjustment. Results sixty-one patients (mean age±SD: 48.43±18,2; male: 41%) who underwent CMR for acute or recurrent pericarditis were enrolled. Pericardial LGE and pericardial oedema detected on T2w were observed in 28(46%) and 31(50.8%) patients, respectively. Pericardial LGE median amount was 31.2(9.02;54.54)gr, 42.73(17.16;72.5)gr and 38.79(15.21;68.5)gr when measured with FWHM, 5SD and 6SD technique, respectively. Median pericardial T1 and T2 values were 1356(1305;1523)ms and 77(73;81)ms, respectively. During a median clinical follow up (FU) of 23(12;66) months, 17(28%) patients had a recurrence of pericarditis, 2(3%) developed constrictive pericarditis requiring pericardiectomy, 2(3%) were hospitalized for heart failure. Quantitative LGE, but neither T1 nor T2 mapping values nor T2w image, was associated to pericarditis recurrence and to composite outcome including constrictive evolution and heart failure hospitalization. The most accurate LGE method in prediction of clinical outcome was FWHM (HR 1.421; IC 1.124-1.795). Conclusion Quantitative LGE evaluation with different techniques, but not parametric mapping, showed an association with prediction of clinical recurrence of acute pericarditis, confirming LGE currently represents the most accurate imaging marker with prognostic value in this setting.CMR pericardial tissue characterization standardized HR pericarditis outcome

Abstract Background Recurrence is the most frequent pericarditis complication. Although Anakinra, an anti-IL-1 agent, has become standard of care for acute idiopathic recurrent pericarditis, no evidence exists on the best selection criteria for its use. Moreover, the prognostic role of non-guideline-based initial therapy in pericarditis has not been studied. Purpose 1) to analyse the real-world use of guideline-based medical therapy in pericarditis, 2) to compare patients with a complicated (recurrent, incessant or chronic) and uncomplicated pericarditis presentation, 3) to describe how a readjustment of first-line medical therapy may reduce Anakinra use. Methods Pericarditis patients followed-up at our Cardio-immunology outpatient clinic were included. Patients were classified among uncomplicated and complicated pericarditis presentation. After referral to our center, medical tratment for pericarditis was considered non—guideline based based on these criteria: 1) inadequately low dosage without contraindications, 2) inadequate drug combinations (i.e. omitting colchicine or using corticosteroids as first-line), 3) excessively fast tapering. Medical therapy was readjusted when appropriate and subsequent pericarditis recurrences were recorded. Univariable regression models were used to assess for pericardtis recurrence predictors. Results We retrospectively included 248 pericarditis patients (median age 49 years old, 59% male); 104 (42%) were referred with a history of complicated pericarditis. Idiopathic or presumed viral aetiology was the most common (78%). Fist-line pericarditis treatment included colchicine (74%), non-steroidal anti-inflammatory drugs (NSAIDs, 86%), and steroids (23%), and was not in line with ESC guidelines in 24%. After 18 months median follow-up, persistent chest pain was reported in only 5.2% cases. Treatment at last follow-up had changed significantly after referral to our centre: 76% patients were on colchicine, 13% on NSAIDs and 13% on steroids. Remarkably, out of the 248 total patients, and of the 104 previously classified complicated pericarditis patients, after medical therapy readjustment only 26 (6%) patients required treatment with anakinra. Patients with complicated pericarditis had been less frequently treated with colchicine (71% vs. 87% p=0.035), and more frequently with steroids (38% vs. 13%. p<0.001) than uncomplicated patients. On univariable analysis, appropriate NSAID treatment was significantly associated with lower recurrence risk (OR = 0.22, 95% CI: 0.08–0.58, p = 0.002), suggesting that guideline-based NSAID use is protective. Conclusions First-line treatment for acute pericarditis is not in line with ESC guidelines in a relevant proportion of cases. For the first time, a predictive role of inappropriate first-line NSAID treatment for recurrence has been identified. A simple readjustment of treatment, i.e. re-challenge of guideline-based first-line drugs, may reduce the need for Anakinra.

Abstract Background Pericarditis is traditionally considered confined to the pericardium when high-sensitivity troponin (hs-cTn) and left ventricular ejection fraction (LVEF) are normal. However, conventional echocardiography may overlook subtle myocardial involvement with important implications. Speckle-tracking echocardiography allows a refined evaluation of myocardial deformation via Global Longitudinal Strain (GLS). While GLS has transformed risk stratification in heart failure and cardiomyopathies, its potential role in pericardial diseases remains largely underexplored. Purpose We aimed to assess whether impaired GLS in patients with pericarditis (despite normal hs-cTn and LVEF) correlates with a greater inflammatory burden and can identify individuals at heightened risk of recurrence. Methods In this prospective cohort study, 147 patients with acute or recurrent pericarditis, diagnosed according to 2015 ESC criteria (pericarditic chest pain, friction rub, pericardial effusion, or ECG changes) were recruited from a tertiary pericarditis clinic. All patients had preserved LVEF and negative hs-cTn at baseline, and underwent left ventricular GLS assessment at presentation and at 6 months. Those with hs-cTn elevation, impaired LVEF, wall motion abnormalities, inadequate acoustic windows, or active pericarditis at 6 month visit were excluded. Echocardiographic assessments were performed using the same ultrasound system by an EACVI-certified cardiologist, with 50 scans re-analysed blinded by a second expert. Results The cohort had a mean age of 44±18 years, 60% female, 83% idiopathic aetiology and 84% presenting with recurrent pericarditis. Baseline LVEF was 59±5%. GLS improved significantly from baseline to follow-up (from -19.4±2.7% to -20.9±2.3%, p<0.01, Figure 1A), suggesting reversibility of myocardial strain abnormalities with inflammation resolution. Dividing the cohort at the mean GLS value of -19.4%, those with a worse baseline GLS (>-19.4%) were more likely to have elevated C-reactive protein (CRP): 32% vs 16%, p=0.034. Over an 18-month follow-up, recurrent pericarditis occurred in 44% and was more common in those with impaired baseline GLS (59% vs 32%, p=0.017, Figure 1B). In Cox regression analysis, baseline GLS > -19.4% (HR=2.15), female gender (HR=2.19), baseline CRP elevation (HR=1.90), and prior corticosteroid use (HR=1.99; Table 1, Figure 2) were independently associated with recurrent pericarditis. Conclusions Our findings suggest that GLS assessment in pericarditis could provide valuable clinical insights beyond conventional markers. The association between impaired GLS and elevated CRP suggests a higher inflammatory burden and possible subclinical myocardial involvement. Moreover, patients with impaired GLS were at increased risk of recurrence, supporting the potential of GLS as a prognostic tool. This may enable earlier identification of high-risk patients and facilitate more personalised, targeted therapeutic strategies.FIGURE 1A/B TABLE 1

Acute pericarditis is an inflammatory condition of the pericardium, often presenting with chest pain, pericardial friction rub, and characteristic ECG changes. The management of acute pericarditis typically involves anti-inflammatory therapy to alleviate symptoms and prevent recurrence. Colchicine has emerged as a key therapeutic agent due to its efficacy in reducing recurrence rates. However, the optimal combination of colchicine with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen remains unclear. This meta-analysis aims to compare the efficacy and safety of colchicine alone versus colchicine combined with aspirin or ibuprofen in the treatment of acute pericarditis. Search Strategy: A comprehensive literature search was conducted using PubMed, EMBASE, and Cochrane Library databases from inception to 2025. The search terms included 'acute pericarditis,' 'colchicine,' 'aspirin,' 'ibuprofen,' and 'NSAIDs.' Reference lists of relevant articles were also screened for additional studies. Inclusion Criteria: Randomized controlled trials (RCTs) comparing colchicine alone, colchicine plus aspirin, and colchicine plus ibuprofen in adults with acute pericarditis. Studies reporting outcomes such as symptom resolution, recurrence rates, and adverse events. Exclusion Criteria: Non-randomized studies, case reports, and reviews. Studies with incomplete data on primary outcomes. The results of this meta-analysis indicate that the combination of colchicine with aspirin or ibuprofen is more effective in reducing recurrence rates and improving symptom resolution in acute pericarditis compared to colchicine alone. Specifically, the pooled recurrence rates were lowest in the colchicine plus aspirin group (14–15%), followed by colchicine plus ibuprofen (17– 18%), and highest in the colchicine alone group (20%). Similarly, symptom resolution rates were highest in the colchicine plus aspirin group (85–86%), followed by colchicine plus ibuprofen (82– 83%), and lowest in the colchicine alone group (80%). This meta-analysis highlights the potential benefits of combining colchicine with nonsteroidal anti-inflammatory drugs (NSAIDs), particularly aspirin, in the management of acute pericarditis. While colchicine alone remains an effective therapy for reducing recurrence, the addition of NSAIDs appears to enhance both symptom resolution and recurrence prevention. Among the combinations studied, colchicine plus aspirin demonstrated the most favorable outcomes.