High risk of coronary artery aneurysm in Kawasaki disease
Maria Mossberg1, Aladdin J Mohammad2,3,4, Fredrik Kahn5
1Section of Pediatrics, Pediatrics, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden.
Insights
Kawasaki disease (KD) poses a high risk of coronary artery aneurysms (CAA). Young children with incomplete KD are particularly vulnerable, emphasizing the need for prompt treatment to prevent CAA.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Vasculitis Research
Background:
- Kawasaki disease (KD) is an acute febrile vasculitis affecting medium-sized arteries, primarily in children.
- Untreated KD carries a significant risk of developing coronary artery aneurysms (CAA), a serious complication.
- Intravenous immunoglobulin (IVIG) is the standard treatment to reduce the incidence of CAA.
Purpose of the Study:
- To identify factors associated with the development of coronary artery aneurysms (CAA) in children diagnosed with Kawasaki disease (KD).
- To investigate the relationship between age, KD classification (complete vs. incomplete), and CAA risk.
- To analyze the impact of treatment timing on CAA development.
Main Methods:
- Retrospective analysis of clinical and demographic data from 77 children diagnosed with KD between 2004 and 2014 in Skåne.
- KD diagnosis adherence to the American Heart Association revised criteria, classifying patients into complete KD (cKD) or incomplete KD (iKD).
- Multivariate analysis to determine associations between patient characteristics and CAA development.
Main Results:
- Overall, 31% of KD patients developed CAA.
- Children with CAA were younger (median 20 months) than those without (median 34 months).
- Incomplete KD (iKD) patients had a higher incidence of CAA (47%) compared to complete KD (cKD) patients (21%).
- Younger age in iKD patients was significantly associated with an increased risk of CAA.
Conclusions:
- The risk of CAA is notably high in young children with incomplete KD.
- Early and intensive treatment is crucial, especially in infants who are challenging to diagnose.
- Vigilance and prompt intervention are essential to mitigate CAA frequency in Kawasaki disease.
Objective:
Kawasaki disease (KD) is a vasculitis of unknown aetiology with a high risk of coronary aneurysms if untreated. Timely treatment with intravenous immunoglobulin decreases the risk for coronary artery aneurysms (CAA). In this study, we set out to elucidate the factors associated with the risk of developing CAA.
Methods:
Records of all KD-diagnosed children in Skåne between 2004 and 2014 were collected and clinical and demographic data were compiled. KD is defined according to the revised American Heart Association diagnostic criteria and classified as either complete KD (cKD) or incomplete KD (iKD).
Results:
KD was diagnosed in 77 children and CAA was found in 31% (n = 24). Children with CAA were younger compared with children without (median; 20 vs 34 months) and intravenous immunoglobulin treatment within 10 days was less likely to be received (75% vs 91%). In children presenting with iKD, 47% developed CAA compared with 21% in cKD patients. Using multivariate analysis, an association between the risk of CAA with low age in children with iKD was observed.
Conclusion:
The risk of CAA development is disturbingly high in young children with iKD. This highlights the importance of rapid intense treatment and vigilance in infants, who are the most difficult to diagnose, in order to reduce the frequency of CAA.
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