Prevalence of coronary artery abnormality in incomplete Kawasaki disease
Tomoyoshi Sonobe1, Nobuyuki Kiyosawa, Keiji Tsuchiya
1Department of Pediatrics, Japanese Red Cross Medical Center, Tokyo, Japan. tomsony@k5.dion.ne.jp
Insights
Incomplete Kawasaki disease (iKD) is not mild; it shows a high prevalence of coronary artery abnormality (CAA). Early diagnosis of iKD, even with few symptoms, is crucial to prevent CAA.
Area of Science:
- Pediatrics
- Cardiology
- Rheumatology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Incomplete Kawasaki disease (iKD) presents with fewer than the classic five principal symptoms.
- Coronary artery abnormality (CAA) is a serious complication of KD.
Purpose of the Study:
- To determine the prevalence of coronary artery abnormality (CAA) in patients with incomplete Kawasaki disease (iKD).
- To analyze other clinical features associated with iKD.
- To utilize data from the 17th Japanese nationwide survey of KD.
Main Methods:
- iKD defined as four or fewer principal symptoms of KD, irrespective of CAA presence.
- Analysis of 15,857 KD cases from a Japanese nationwide survey.
- Comparison of CAA prevalence between complete KD (cKD) and iKD.
Main Results:
- 16.1% of KD cases were classified as iKD; 83.9% as cKD.
- CAA prevalence was 18.4% in iKD versus 14.2% in cKD.
- CAA prevalence was higher in patients with four symptoms (18.1%) and one to three symptoms (19.3%) compared to cKD.
Conclusions:
- iKD should not be considered mild; it carries a significant risk of CAA.
- Patients with four symptoms showed CAA occurrence comparable to cKD.
- Early diagnosis of iKD, especially in infants and older children, is vital for preventing CAA, emphasizing the importance of other symptoms and lab findings.
Background:
The aim of the present study was to determine the prevalence of coronary artery abnormality (CAA) and other clinical features in patients with incomplete Kawasaki disease (iKD) using the data from the 17th Japanese nationwide survey of KD.
Methods:
iKD was defined as the presence of four or fewer of the principal symptoms of the Japanese diagnostic guidelines, regardless of whether the patient had CAA. A total of 15,857 cases were analyzed.
Results:
Among 15,857 cases, 83.9% of patients had five to six principal symptoms (complete KD: cKD), and 16.1% had iKD. The prevalence of CAA in cKD was 14.2%, and 18.4% in iKD. The prevalence of CAA in patients with four principal symptoms was 18.1%, which was higher than in cKD cases (14.2%). Although the reliability of the data has some limitations, the prevalence of CAA among patients with one to three symptoms was 19.3%. Among all CAA patients, 14% had four symptoms, and 6% had only one to three symptoms.
Conclusion:
Incomplete KD should not be equated with mild KD. Patients with four principal symptoms were comparable to cKD with respect to CAA occurrence. In patients with one to three symptoms also, especially in those under 1 year and older than 4 years of age, other significant symptoms and laboratory findings of the guidelines are very important in making a correct and early diagnosis of iKD so as to prevent CAA.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Coronary Artery Disease II: Pathophysiology
01:30Coronary Artery Disease III: Clinical Manifestations
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:30Coronary Artery Disease I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care