Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous γ-immunoglobulin therapy

Lin, Min; Sun, Li-Chuan; Wu, En‐Ting; Wang, Jou‐Kou; Lue, Hung-Chi; Wu, Mei‐Hwan

doi:10.1136/archdischild-2014-306427

Cited by 89 publications

(65 citation statements)

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“…In a Taiwanese study evaluating KD patients including 27 patients with giant CAA (≥8 mm), the same result was found [9]. On the other hand, a recent study reviewing 90 US patients with giant CAA based on z-scores, found that in 19% of the patient with giant CAA regression occurred [10].…”

Section: Discussionsupporting

confidence: 57%

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Regression and Complications of z-score-Based Giant Aneurysms in a Dutch Cohort of Kawasaki Disease Patients

et al. 2017

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Kawasaki disease (KD) is a pediatric vasculitis. Its main complication is the development of coronary artery aneurysms (CAA), with giant CAA at the end of the spectrum. We evaluated regression and event-free rates in a non-Asian cohort of patients with giant CAA using the current z-scores adjusted for body surface area instead of absolute diameters. KD patients with giant CAA (z-score ≥10) visiting our outpatient clinic between January 1999 and September 2015 were included. Patient characteristics and clinical details were extracted from medical records. Regression was defined as all coronary arteries having a z-score of ≤3. A major adverse event was defined as cardiac death, myocardial infarction, cardiogenic shock, or any coronary intervention. Regression-free and event-free rates were calculated using the Kaplan–Meier method. We included 52 patients with giant CAA of which 45 had been monitored since the acute phase. The 1-, 2-, and 5-year regression-free rates were 0.86, 0.78, and 0.65, respectively. The 5-year, 10-year, and 15-year event-free rates were 0.79, 0.75, and 0.65, respectively. Four children, whose CAA would not have been classified as ‘giant’ based on absolute diameters instead of z-scores, had experienced an event during follow-up. Conclusion: We found a high percentage of children in whom the lumen of giant CAA completely normalized. Four children not classified as ‘giant’ based on absolute diameters with z-scores of ≥10 experienced a cardiac event. Hence, the use of z-scores seems to be justified.Electronic supplementary materialThe online version of this article (doi:10.1007/s00246-017-1590-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 57%

“…Our finding that regression mainly takes place in the first 5 years is supported by earlier studies. Lin et al found a 5-year persistence rate of 46% for medium-sized CAA with little regression after [9]. Kato et al, studying a group of patients with CAA of all sizes, found that 90% of regression occurred within the first 2 years [11].…”

Section: Discussionmentioning

confidence: 99%

Regression and Complications of z-score-Based Giant Aneurysms in a Dutch Cohort of Kawasaki Disease Patients

et al. 2017

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“…96 Long-term prognosis in children with coronary artery aneurysms is predicted in part by coronary artery size at 1 month of illness, with the 10-year ischemia event-free and aneurysm persistence probability being 87.5% and 20.6%, respectively. 113 Successful surgical treatment (eg, CABG) of late sequelae of symptomatic coronary artery stenoses has been described. 114 …”

Section: Congenital Cardiovascular Defects and Kawasaki Diseasementioning

confidence: 99%

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Benjamin¹,

Blaha²,

Chiuve³

et al. 2017

Circulation

7,718

5,040

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“…The number of coronary aneurysms in our cohort of patients was relatively high (19.6%), similar to those in the group without IVIG treatment, where the incidence of coronary aneurysms was between 20% and 25% [24]. The infusions with IVIG in Bulgaria started in 1998, but only in a limited number of patients.…”

Section: Treatment Of Patients With Kawasaki Diseasementioning

confidence: 65%

Kawasaki disease – experience of Pediatric University Hospital, Sofia, Bulgaria, 1993–2014. Part II: cardiovascular manifestations and treatment

Telcharova-Mihaylovska

Nikolova

Marinov

et al. 2017

Biotechnology & Biotechnological Equipment

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Kawasaki disease (KD) is a childhood vasculitis syndrome and the coronary arteries are the main target of the vascular damage. The outcome is formation of coronary lesions (CL) that develop in 20%-25% of untreated children. KD is the leading cause of myocardial infarction in infancy. Its consequences among young people are acute coronary syndrome and susceptibility to early atherosclerosis, if the disease were to remain unrecognized. We investigated the cardiac manifestations during the acute phase of the disease, the values of the fever, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and the therapeutic factors that created increased coronary risk in our cohort of patients. The study is retrospective . In the cohort (n = 107), 30.8% had coronary lesions, including 19.6% coronary aneurysms and 11.2% significant dilatations. We found association between myocarditis, papillary and left ventricular dysfunction in the acute phase of KD and the risk of coronary aneurysms (p < 0.001). The expressively elevated CRP levels and the persistent fever during the early subacute phase correlated significantly with coronary risk (p < 0.002). The treatment with intravenous immunoglobulin (IVIG) reduced the risk of coronary aneurysms 4.8 times (p < 0.002). A follow-up was performed in 53 children with coronary lesions during the first year of the disease. A longitudinal follow-up was performed in 38 patients. Their results indicate that cardiac monitoring is obligatory for all patients who have experienced KD.

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Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous γ-immunoglobulin therapy

Cited by 89 publications

References 20 publications

Regression and Complications of z-score-Based Giant Aneurysms in a Dutch Cohort of Kawasaki Disease Patients

Regression and Complications of z-score-Based Giant Aneurysms in a Dutch Cohort of Kawasaki Disease Patients

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Kawasaki disease – experience of Pediatric University Hospital, Sofia, Bulgaria, 1993–2014. Part II: cardiovascular manifestations and treatment

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