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Risk factors and long-term follow-up in acute Kawasaki disease patients with medium or large coronary artery

Wei Li1, Yuantao Tong2, Xiqiao Xue1

  • 1Department of Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.

Clinical and Experimental Rheumatology
|August 3, 2026
PubMed

Insights

Delayed IVIG treatment and IVIG resistance are risk factors for Kawasaki disease (KD) patients with medium or large coronary artery abnormalities (CAA). Long-term prognosis for medium and large CAA is poor, especially for large CAA.

Area of Science:

  • Pediatrics
  • Cardiology
  • Rheumatology

Background:

  • Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
  • Medium or large coronary artery abnormalities (CAA) in KD patients require further investigation.
  • Limited data exists on risk factors and long-term outcomes for KD patients with medium/large CAA in Chinese populations.

Purpose of the Study:

  • To identify risk factors for developing medium or large CAA in Kawasaki disease.
  • To evaluate the long-term follow-up and prognosis of KD patients with medium or large CAA.
  • To analyze the regression rates and thrombosis development in different CAA categories.

Main Methods:

  • A cohort study of 220 KD patients (55 with medium/large CAA, 165 without CAA) was conducted from January 2015 to April 2020.
  • Univariate and multivariate logistic regression analyses were employed to determine risk factors.
  • Patients were followed up for over 12 months to assess long-term outcomes.

Main Results:

  • Independent risk factors for medium/large CAA included delayed IVIG treatment, IVIG resistance, low albumin, and low platelet count.
  • At 49 months follow-up, 54.3% of medium CAA regressed, but none of the large CAA cases resolved.
  • Coronary thrombosis increased from 20% in acute phase to 32.7% at follow-up, predominantly in the large CAA group.

Conclusions:

  • Delayed IVIG, IVIG resistance, albumin, and platelet count are significant risk factors for medium/large CAA in KD.
  • The long-term prognosis for medium and large CAA is concerning, with large CAA showing a particularly poor outlook.
  • Close monitoring and timely intervention are crucial for KD patients with coronary artery abnormalities.
Abstract

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