Progressive Coronary Dilatation Predicts Worse Outcome in Kawasaki Disease
Journal
Journal of Pediatrics
Journal Volume
171
Pages
78-82
Date Issued
2016
Author(s)
Abstract
Objective To explore the implication of serial coronary changes on the late coronary outcomes in patients with Kawasaki disease (KD) with coronary aneurysms ?4 mm. Study design We performed a retrospective review of 78 patients with KD with large coronary aneurysms (1980-2013, male: 76.9%; 792 patient-years). Progressive coronary dilatation was defined for those with progressive enlargement of coronary arteries in 3 consecutive echocardiograms. Results We studied 27 patients with KD with giant aneurysms (?8 mm) and 51 patients with KD with medium aneurysms (4-8 mm). All the giant and 43.1% of medium aneurysms persisted during the study period. For the patients with giant aneurysms, their 10-year freedom from acute myocardial infarction/cardiovascular death and all ischemia was 66% and 52%, respectively. The median intervals for the aneurysm diameters reaching their peak were 3.3 months (giant) and 0.25 months (medium), respectively. In patients with giant aneurysms, the 10-year freedom from ischemia was much lower in those with progressive coronary dilatation (28% vs 59%, P =.021). In patients with medium aneurysms, the probability of 5-year persistence of aneurysm was much greater (67.2% vs 14.8%, P < 10-3) in those with progressive coronary dilatation. Male sex and intravenous immunoglobulin therapy were not associated with the late outcomes in the patients with KD who had aneurysms larger than 4 mm. Conclusions In addition to coronary diameters 1 month after the onset of KD, progressive coronary dilatation at 2 or more months after diagnosis may be an indicator of duration, and the severity of vasculitis and adverse dilative remodeling were associated with worse late coronary outcomes. ? 2016 Elsevier Inc.
SDGs
Other Subjects
acetylsalicylic acid; warfarin; immunoglobulin; acute heart infarction; adolescent; adult; aneurysm; Article; computer assisted tomography; coronary artery aneurysm; coronary artery dilatation; echocardiography; electrocardiogram; female; follow up; heart failure; heart infarction; human; immunotherapy; infant; ischemia; long term care; longitudinal study; major clinical study; male; mucocutaneous lymph node syndrome; outcome assessment; prediction; priority journal; retrospective study; ST segment; sudden cardiac death; body size; chemistry; child; complication; Coronary Aneurysm; coronary artery blood flow; coronary blood vessel; dilatation; heart muscle ischemia; Kaplan Meier method; mucocutaneous lymph node syndrome; pathology; preschool child; time factor; treatment outcome; Adolescent; Body Size; Child; Child, Preschool; Coronary Aneurysm; Coronary Circulation; Coronary Vessels; Dilatation; Echocardiography; Female; Humans; Immunoglobulins, Intravenous; Infant; Kaplan-Meier Estimate; Male; Mucocutaneous Lymph Node Syndrome; Myocardial Infarction; Myocardial Ischemia; Retrospective Studies; Time Factors; Treatment Outcome
Publisher
Mosby Inc.
Type
journal article