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Outcome of coronary artery aneurysms after Kawasaki disease
1Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Kawasaki disease can cause coronary artery aneurysms in children. While smaller aneurysms often resolve, giant aneurysms persist, and IVIG treatment may reduce severe lesions.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms are a significant complication, potentially leading to myocardial infarction.
- Understanding aneurysm regression and influencing factors is crucial for patient outcomes.
Purpose of the Study:
- To investigate the long-term regression rates of coronary artery aneurysms in children with Kawasaki disease.
- To identify factors influencing aneurysm regression, including aneurysm size, initial treatment, and patient demographics.
- To evaluate the impact of immune globulin (IVIG) therapy on coronary lesion severity and resolution.
Main Methods:
- Retrospective analysis of 583 children diagnosed with Kawasaki disease between 1974 and 1991.
- Categorization of coronary artery lesions into dilation, moderate, and giant aneurysms.
- Multivariate analysis to determine predictors of aneurysm regression.
- Comparison of outcomes between patients treated with salicylate alone versus those receiving IVIG therapy.
Main Results:
- 13.7% of children developed coronary artery involvement, with 9% experiencing myocardial infarction (all with giant aneurysms).
- Giant aneurysms (> or = 8 mm) showed no regression during follow-up, unlike smaller lesions.
- Regression was significantly associated with lesion severity, initial treatment, and gender.
- IVIG therapy was linked to more rapid resolution and a higher proportion of small/moderate lesions compared to salicylate alone.
Conclusions:
- The initial severity of coronary artery lesions in Kawasaki disease is a key determinant of aneurysm regression.
- Giant aneurysms represent a persistent risk and do not typically regress.
- Immune globulin therapy appears to improve outcomes by potentially reducing the incidence of severe coronary artery lesions.
Abstract:
From 1974 through 1991, a total of 583 children with Kawasaki disease were seen at the Hospital for Sick Children, in Toronto, of whom 80 (13.7%) had coronary artery involvement. There were 55 boys and 25 girls, whose mean age at onset was 2.9 +/- 2.5 years, followed for a mean period of 4.0 +/- 3.6 years. Giant aneurysms (maximum diameter > or = 8 mm) were found in 22 children, moderate-sized aneurysms (> or = 4 to < 8 mm) in 44, and dilation lesions (< 4 mm) in 14. Myocardial infarction occurred in 9 (1.5%), all of whom had giant aneurysms. The persistence rate for aneurysms was 72% at 1 year and 41% at 5 years of follow-up. In multivariate analysis, the regression of an aneurysm was significantly related to the severity of coronary artery lesions, initial treatment, and gender. Although > 80% of small or moderate-sized aneurysms regressed within 5 years, giant aneurysms did not regress during the follow-up period. In patients who received immune globulin therapy, coronary lesions tended to resolve more rapidly than in those treated with salicylate therapy alone, because 91% of the lesions in the former were small or moderate. These findings suggest that the severity of coronary artery involvement during the initial stages of Kawasaki disease influences the regression of these lesions, and that immune globulin treatment may improve outcome by reducing the incidence of severe lesions.