Long-term Cardiovascular and Psychological Outcomes of Multisystem Inflammatory Syndrome in Children: A Prospective Observational Study (COPE MIS-C study).

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is associated with favorable short-term outcomes. However, long-term follow-up data are limited, particularly from low- and middle-income countries. METHODOLOGY: This prospective follow-up study was conducted at a tertiary care hospital in North India between November 2024 and September 2025, involving children (n = 51) admitted with MIS-C and discharged between September 2020 and August 2022. The data collected included the clinical profile, echocardiography (left ventricular ejection fraction and coronary artery diameters), Screen for Child Anxiety-Related Disorders scale, UCLA Post-traumatic Stress Disorder Reaction Index and Vineland Social Maturity Scale. RESULTS: During the acute phase, common manifestations included fever, gastrointestinal and mucocutaneous involvement, shock, elevated inflammatory markers, myocardial dysfunction (47%) and coronary abnormalities (22%). At follow-up 44 (43-46) months after discharge, none had major clinical symptoms; all had normalized left ventricular ejection fraction, normal school performance and peer relationships; and only 12% had mild coronary artery abnormalities. There were no anxiety or post-traumatic stress disorder-related symptoms, and all had age-appropriate social maturity. CONCLUSIONS: Long-term outcomes of MIS-C are favorable, with complete recovery of myocardial function, persistent mild coronary abnormalities in a small proportion, no anxiety or post-traumatic stress disorder, and normal social maturation.