Incidence of Stenotic Lesions Predicted by Acute Phase Changes in Coronary Arterial Diameter During Kawasaki Disease

Abstract

To clarify the incidence of stenotic lesions according to the coronary arterial diameter in the acute phase. we investigated 190 patients with coronary arterial lesions who underwent an initial coronary angiogram (CAG) less than 100 days after the onset of Kawasaki disease. The largest diameters of the major branches were measured in the initial CAGs. The diameter of the large group was > or = 8.0 mm, that of the medium group was > or = 6.0 mm but < 8.0 mm, and that of the small group was > or = 4.0 mm but < 6.0 mm. There were 121 patients in the large group, 85 in the medium group, 77 in the small group. We investigated the stenotic lesions in the follow-up CAGs and evaluated the incidence of stenotic lesions in each group by the Kaplan-Meier method. The mean interval from the initial CAGs to the latest CAG was 97 months. The incidence of stenosis at 5, 10, and 15 years in the large group was 44, 62, and 74%, respectively. In the medium group the corresponding values were 6, 20, 58%, respectively. None of the patients in the small group developed stenotic lesions. Dilatation of more than 6.0 mm produces a high probability of irreversible change in the coronary arterial wall, leading to subsequent stenotic lesions.

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

“…A previous study demonstrated that at a 10-year follow-up, the probabilities of regression and developing stenosis of the medium coronary aneurysms were 32% and 20%, respectively. 22 They also suggested a cut-off threshold for the development of stenosis as 6 mm for coronary aneurysms, which was not observed in this study.…”

Nationwide Survey of Patients With Giant Coronary Aneurysm Secondary to Kawasaki Disease 1999–2010 in Japan

“…5 In 1 report, intimal proliferation tended to occur when aneurysm size exceeded 4 mm. 9 Another study said medium-sized (6-8-mm) aneurysms developed stenosis in 6%, 28%, and 52% of cases after 5, 10, and 15 years of KD onset, respectively, giant aneurysms developed stenosis in 44%, 62%, and 74% of cases, respectively, 10 and this trend was confirmed by another group. 11 In the present study, total cardiac events were more likely to occur in patients with giant coronary aneurysm ≥10 mm compared with those ≥8 and <10 mm in both the RCA and LCA (Supplementary Results).…”

Different subgroups regarding the absence of rescue therapy in intravenous immunoglobulin-resistant Kawasaki disease

“…Long-term follow-up studies have shown that a maximum CAL size >5 mm was a statistically significant predictive risk factor for myocardial ischemia, and that all CAL ≤5 mm in size regressed to normal size [17]. Another study reported that the threshold diameter for acute phase CAL that developed into subsequent stenosis was 6.0 mm [18]. Therefore, the prevention of CAL of >5 mm may be an important goal in the acute treatment of Kawasaki disease to prevent coronary artery stenosis in later stages of the disease [19].…”