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Outcomes of Kawasaki disease with giant coronary aneurysms: a single-centre study in southwest China

Published online by Cambridge University Press:  08 June 2020

Piaoliu Yuan Open the ORCID record for Piaoliu Yuan [Opens in a new window] ,
Danyan Su ,
Krishna D. Mandal ,
Suyuan Qin ,
Na Zhao  and
Yusheng Pang
Piaoliu Yuan
Affiliation:
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, PR China
Danyan Su
Affiliation:
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, PR China
Krishna D. Mandal
Affiliation:
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, PR China
Suyuan Qin
Affiliation:
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, PR China
Na Zhao
Affiliation:
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, PR China
Yusheng Pang*
Affiliation:
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, PR China
*
Author for correspondence: Yusheng Pang, MD, PhD, Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning530021, Guangxi Autonomous Region, PR China. Tel: +86 07715331053; Fax: +86 5356780. E-mail: pangyush@163.com
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Abstract

Background:

Giant coronary aneurysms are the most severe complications of Kawasaki disease. There are few reports of outcomes from China. Most previous studies were based only on absolute aneurysmal dimensions. The aim of the present study was to catalog the outcomes of Kawasaki disease with giant coronary aneurysms in southwest China based on absolute dimensions and the z-score adjusted for body surface area.

Methods and results:

All patients diagnosed with giant coronary aneurysms (z-score ≥ 10 or absolute dimension ≥ 8 mm) between December, 2002 and December, 2018 were included. We retrospectively analysed patient characteristics and clinical data from 38 patients with giant coronary aneurysms. Over a median follow-up period of 30.5 months (range from 1.7 months to 22.3 years), including patients in chronic phase who had been diagnosed prior to 2002, eight patients had myocardial infarction, including two deaths and one patient with coronary artery bypass grafting. The 1-, 2-, and 5-year event-free rates were 0.63, 0.63, and 0.53 for thrombosis, respectively, and 0.86, 0.81, and 0.81 for major adverse cardiac events, respectively. The 1-, 2-, and 5-year regression-free rates were 0.94, 0.85, and 0.67, respectively. A total of 73.7% of patients remained active.

Conclusion:

In the early stages of Kawasaki disease, patients with giant coronary aneurysms often experience major cardiovascular events; however, they are also likely to have normalisation of the coronary internal luminal diameter. With long-term anticoagulation, close cardiologic monitoring, and prompt thrombolytic therapy, most patients can achieve disease-free periods.

Keywords

Kawasaki diseasegiant coronary aneurysmsoutcomefollow-upmyocardial infarction
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 6 , June 2020 , pp. 834 - 839
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Piaoliu Yuan and Danyan Su contributed equally to this work and should be considered co-first authors.

References

McCrindle, BW, Rowley, AH, Newburger, JW, et al.Diagnosis, treatment, and long-term management of Kawasaki disease a scientific statement for health professionals from the American Heart Association. Circulation 2017; 135: E927–E999.CrossRefGoogle ScholarPubMed
Singh, S, Vignesh, P, Burgner, D.The epidemiology of Kawasaki disease: a global update. Arch Dis Child 2015; 100: 1084–1088.10.1136/archdischild-2014-307536CrossRefGoogle ScholarPubMed
Garrido-Garcia, LM, Moran-Villasenor, E, Yamazaki-Nakashimada, MA, Cravioto, P, Galvan, F.Giant coronary artery aneurysms complicating Kawasaki disease in Mexican children. Cardiol Young 2018; 28: 386–390.CrossRefGoogle ScholarPubMed
Burns, JC, Shike, H, Gordon, JB, Malhotra, A, Schoenwetter, M, Kawasaki, T.Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol 1996; 28: 253–257.CrossRefGoogle ScholarPubMed
Miura, M, Kobayashi, T, Kaneko, T, et al.Association of severity of coronary artery aneurysms in patients with Kawasaki disease and risk of later coronary events. JAMA Pediatr 2018; 172: e180030.10.1001/jamapediatrics.2018.0030CrossRefGoogle ScholarPubMed
Tang, Y, Yan, W, Sun, L, Xu, Q, Ding, Y, Lv, H.Coronary artery aneurysm regression after Kawasaki disease and associated risk factors: a 3-year follow-up study in East China. Clin Rheumatol 2018; 37: 1945–1951.CrossRefGoogle ScholarPubMed
Tang, Y, Gao, X, Shen, J, Sun, L, Yan, W.Epidemiological and clinical characteristics of Kawasaki disease and factors associated with coronary artery abnormalities in East China: nine years experience. J Trop Pediatr 2016; 62: 86–93.CrossRefGoogle ScholarPubMed
Newburger, JW, Takahashi, M, Gerber, MA, et al.Diagnosis, treatment, and long-term management of Kawasaki disease – a statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association. Circulation 2004; 110: 2747–2771.CrossRefGoogle Scholar
Kobayashi, T, Fuse, S, Sakamoto, N, et al.A new z score curve of the coronary arterial internal diameter using the Lambda-Mu-Sigma method in a pediatric population. J Am Soc Echocardiogr 2016; 29: 794–801.e29.CrossRefGoogle Scholar
Wang, YJ, Wang, W, Gong, FQ, et al.Evaluation of intravenous immunoglobulin resistance and coronary artery lesions in relation to Th1/Th2 cytokine profiles in patients with Kawasaki disease. Arthritis Rheum 2013; 65: 805–814.CrossRefGoogle ScholarPubMed
Fukazawa, R, Kobayashi, T, Mikami, M, et al.Nationwide survey of patients with giant coronary aneurysm secondary to Kawasaki disease 1999–2010 in Japan. Circ J 2018; 82 (1): 239–246.CrossRefGoogle Scholar
Patel, AS, Bruce, M, Harrington, W, Portman, MA.Coronary artery stenosis risk and time course in Kawasaki disease patients: experience at a US tertiary pediatric centre. Open Heart 2015; 2: e000206.CrossRefGoogle Scholar
McNeal-Davidson, A, Fournier, A, Scuccimarri, R, et al.The fate and observed management of giant coronary artery aneurysms secondary to Kawasaki disease in the province of Quebec: the complete series since 1976. Pediatr Cardiol 2013; 34: 170–178.CrossRefGoogle ScholarPubMed
Uehara, R, Belay, ED.Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol 2012; 22: 79–85.CrossRefGoogle ScholarPubMed
Iemura, M, Ishii, M, Sugimura, T, Akagi, T, Kato, H.Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart 2000; 83: 307–311.CrossRefGoogle ScholarPubMed
Dietz, SM, Kuipers, IM, Koole, JCD, et al.Regression and complications of z-score-based giant aneurysms in a Dutch Cohort of Kawasaki disease patients. Pediatr Cardiol 2017; 38: 833–839.CrossRefGoogle Scholar
Friedman, KG, Gauvreau, K, Hamaoka-Okamoto, A, et al.Coronary artery aneurysms in Kawasaki disease: risk factors for progressive disease and adverse cardiac events in the US population. J Am Heart Assoc 2016; 5: e003289.CrossRefGoogle ScholarPubMed
Lin, MT, Sun, LC, Wu, ET, Wang, JK, Lue, HC, Wu, MH.Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous gamma-immunoglobulin therapy. Arch Dis Child 2015; 100: 542–547.CrossRefGoogle ScholarPubMed
Holve, TJ, Patel, A, Chau, Q, Marks, AR, Meadows, A, Zaroff, JG.Long-term cardiovascular outcomes in survivors of Kawasaki disease. Pediatrics 2014; 133: E305–E311.CrossRefGoogle ScholarPubMed
Su, DY, Wang, K, Qin, SY, Pang, YS.Safety and efficacy of warfarin plus aspirin combination therapy for giant coronary artery aneurysm secondary to Kawasaki disease: a meta-analysis. Cardiology 2014; 129: 55–64.CrossRefGoogle ScholarPubMed
Gupta, AA, Leaker, M, Andrew, M, et al.Safety and outcomes of thrombolysis with tissue plasminogen activator for treatment of intravascular thrombosis in children. J Pediatr 2001; 139: 682–688.CrossRefGoogle ScholarPubMed