Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

Abstract

Risk factors for coronary artery lesion (CAL) development in patients with Kawasaki disease (KD) include male sex, age <12 months, intravenous immunoglobulin (IVIG) resistance, and delayed diagnosis. We aimed to explore the relationship between CAL development and Z-score. We enrolled 281 patients with KD who were treated with our protocol. Echocardiography was performed in three phases: pre-treatment (P1), post-treatment (P2), and 4 weeks after onset (P3). The highest Z-score of the right, left main, left anterior descending, and left circum ex coronary arteries was expressed as Zmax at each phase. P3-Zmax ≥2.5 represented CAL development. Clinical parameters, such as laboratory data and Zscores, were retrospectively compared between patients with and without CAL development. Sixty-seven patients (23.8%) showed a P1-Zmax ≥2.0, and CAL development occurred in 21 patients (7.5%). Independent risk factors associated with CAL development were P1-Zmax, a ΔZmax (P2-Zmax − P1-Zmax) ≥1, male sex, <12 months of age, and resistant to the rst IVIG administration (adjusted odds ratio [95% con dence interval]: 1.

Diagnosis of coronary artery abnormalities in Kawasaki disease: recent guidelines and z score systems

“…The initial coronary z score and the difference between the initial and follow-up z scores could be possible predictors of subsequent coronary artery abnormalities. 42) Also, the diagnosis using z score classification was well correlated and predictive of outcomes, especially in patients with giant aneurysms (z score ≥10). 43,44) In an international study of 34 institutions, patients with a z score <10 did not show luminal narrowing, thrombosis, or major adverse cardiovascular complications.…”

“…The initial coronary z score and the difference between the initial and follow-up z scores could be possible predictors of subsequent coronary artery abnormalities [ 42 ]. Also, the diagnosis using z score classification was well correlated and predictive of outcomes, especially in patients with giant aneurysms ( z score ≥10) [ 43 , 44 ].…”

Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan

“…The third consideration is the predictors of development of CAA, which include sex (male), age (infants and older children), and failure to respond to initial IVIG 20–22 . It has recently been reported that an increase in the coronary artery Z ‐score before initial IVIG treatment (pre‐ Z ‐max) is a risk factor for CAAs 15–17 . Pre‐ Z ‐max can be used to evaluate the coronary arteries directly and may be one of the predictors of CAAs.…”

“…These reports and our results suggest that it may be important to prevent damage to, and dilatation of, the coronary arteries from the early acute phase of KD. It is therefore necessary to determine what the optimal first line protocol is in patients with KD and a high pre‐ Z ‐max 15–17 …”

“…We constructed the ROC curve for pre-Z-max and CAAs because previous research [15][16][17] has indicated that the pre-Z-max is a predictor of development of CAAs. There was no significant difference in the distribution of pre-Z-max between the three groups (1-3, 4-5, and ≥6 days) (data not shown).…”