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Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous γ-immunoglobulin therapy
  1. Ming-Tai Lin1,
  2. Li-Chuan Sun2,
  3. En-Ting Wu1,
  4. Jou-Kou Wang1,
  5. Hung-Chi Lue1,
  6. Mei-Hwan Wu1
  1. 1Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
  2. 2Department of Pediatrics, Cardinal Tien General Hospital, Taipei, Taiwan
  1. Correspondence to Dr Mei-Hwan Wu, Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan; wumh{at}ntu.edu.tw

Abstract

Objective To explore acute and late coronary outcomes and their risk/modifiers in patients with Kawasaki disease (KD).

Design Retrospective study.

Setting and patients 1073 patients with KD identified from a tertiary care medical centre (1980–2012; 8677 patient-years).

Main outcome measures The acute coronary severities and late outcomes (survival free of coronary aneurysm persistence and ischaemia) were assessed.

Results Coronary arterial lesions occurred in 40.6% of cases at their acute febrile stages, and persisted beyond 1 month in 196 (18.3%, M/F=138/58) patients: 125 (11.6%) had small aneurysms, 44 (4.1%) had medium aneurysms, and 27 (2.5%) had giant aneurysms. At follow-up (1–46 years), coronary aneurysms persisted in all with giant aneurysms, in 55% of those with medium aneurysms (18% with stenosis), and in 9% of those with small aneurysms. Ischaemia events occurred in 14 patients (M/F=13/1) and caused four deaths. Among the patients with KD with coronary aneurysms, 10-year ischaemia event-free and aneurysm persistence probability was 87.5% and 20.6%, respectively. The only independent risk for aneurysm persistence was the aneurysm severity 1 month after KD onset (χ2=80.73, p<10−3). Male patients and intravenous γ-immunoglobulin (IVIG) therapy were independent risk factors of initial coronary severity but were not associated with the late coronary outcomes, even in severity stratified subgroups.

Conclusions The coronary severity 1 month after KD onset is most crucial to the late coronary outcomes. Although IVIG use improves the initial severity of coronary lesions, it does not further modify the long-term fate of coronary aneurysms.

  • Cardiology
  • Kawasaki disease
  • Coronary arterial lesions
  • Myocardial ischemia
  • Risk factors

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