Progressive Coronary Dilatation Predicts Worse Outcome in Kawasaki Disease

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• 作者：Wan-Ling Chih ; MD¹ ; ^&lowast ; ; Pei-Yuan Wu ; MD¹ ; ^&lowast ; ; Li-Chuang Sun ; MD² ; Ming-Tai Lin ; MD ; PhD¹ ; ^{mingtailin@ntu.edu.tw" class="auth_mail" title="E-mail the corresponding author} ; Jou-Kou Wang ; MD ; PhD¹ ; Mei-Hwan Wu ; MD ; PhD² ; ^{wumh@ntu.edu.tw" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AMI ; Acute myocardial infarction ; CV ; Cardiovascular ; IVIG ; Intravenous immunoglobulin ; KD ; Kawasaki disease
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：171
• 期：Complete
• 页码：78-82.e1
• 全文大小：475 K

文摘

To explore the implication of serial coronary changes on the late coronary outcomes in patients with Kawasaki disease (KD) with coronary aneurysms ≧4 mm.

Study design

We performed a retrospective review of 78 patients with KD with large coronary aneurysms (1980-2013, male: 76.9%; 792 patient-years). Progressive coronary dilatation was defined for those with progressive enlargement of coronary arteries in 3 consecutive echocardiograms.

Results

We studied 27 patients with KD with giant aneurysms (≧8 mm) and 51 patients with KD with medium aneurysms (4-8 mm). All the giant and 43.1% of medium aneurysms persisted during the study period. For the patients with giant aneurysms, their 10-year freedom from acute myocardial infarction/cardiovascular death and all ischemia was 66% and 52%, respectively. The median intervals for the aneurysm diameters reaching their peak were 3.3 months (giant) and 0.25 months (medium), respectively. In patients with giant aneurysms, the 10-year freedom from ischemia was much lower in those with progressive coronary dilatation (28% vs 59%, P = .021). In patients with medium aneurysms, the probability of 5-year persistence of aneurysm was much greater (67.2% vs 14.8%, P < 10⁻³) in those with progressive coronary dilatation. Male sex and intravenous immunoglobulin therapy were not associated with the late outcomes in the patients with KD who had aneurysms larger than 4 mm.

Conclusions

In addition to coronary diameters 1 month after the onset of KD, progressive coronary dilatation at 2 or more months after diagnosis may be an indicator of duration, and the severity of vasculitis and adverse dilative remodeling were associated with worse late coronary outcomes.