Long-Term Outcomes of Coronary Artery Aneurysms in Children With Kawasaki Disease: A Systematic Review

Area of Science:

• Pediatric Cardiology
• Rheumatology
• Vascular Biology

Background:

• Kawasaki disease (KD) is a leading cause of acquired pediatric heart disease.
• Coronary artery aneurysms (CAAs) are the most serious complication of KD, leading to long-term morbidity and mortality.
• Understanding long-term CAA outcomes is crucial for patient management.

Purpose of the Study:

• To systematically review the long-term outcomes of CAAs in children with KD.
• To analyze CAA regression rates, associated complications, and the impact of medical and surgical interventions.
• To provide evidence for optimizing the long-term care and surveillance of KD patients with CAAs.

Main Methods:

• Systematic review of 21 studies.
• Inclusion of 10,922 patients diagnosed with KD and CAAs.
• Analysis of data on CAA incidence, regression, complications, and treatment outcomes.

Main Results:

• CAA incidence in KD ranged from 3% to 27%, predominantly in infants under 6 months.
• Most small and moderate CAAs (>80%) regressed, unlike giant aneurysms.
• Early intravenous immunoglobulin (IVIG) treatment improved regression rates; left anterior descending artery aneurysms showed less regression.
• Complications included thrombosis, myocardial infarction, major adverse cardiac events, and cardiac death.
• Coronary artery bypass grafting was the primary surgical intervention.

Conclusions:

• Early and aggressive management of KD with IVIG, potentially escalated with steroids or biologics, is preferred.
• Surgical intervention is indicated for giant or persistent CAAs.
• Timely diagnosis, risk stratification, and standardized guidelines are essential for optimal long-term care and surveillance of KD patients with CAAs.