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

AbstractOBJECTIVE:
To explore acute and late coronary outcomes and their risk/modifiers in patients with Kawasaki disease (KD).
DESIGN:
Retrospective study.
SETTING AND PATIENTS:
1073 patients with KD identified from a tertiary care medical centre (1980-2012; 8677 patient-years).
MAIN OUTCOME MEASURES:
The acute coronary severities and late outcomes (survival free of coronary aneurysm persistence and ischaemia) were assessed.
RESULTS:
Coronary arterial lesions occurred in 40.6% of cases at their acute febrile stages, and persisted beyond 1 month in 196 (18.3%, M/F=138/58) patients: 125 (11.6%) had small aneurysms, 44 (4.1%) had medium aneurysms, and 27 (2.5%) had giant aneurysms. At follow-up (1-46 years), coronary aneurysms persisted in all with giant aneurysms, in 55% of those with medium aneurysms (18% with stenosis), and in 9% of those with small aneurysms. Ischaemia events occurred in 14 patients (M/F=13/1) and caused four deaths. Among the patients with KD with coronary aneurysms, 10-year ischaemia event-free and aneurysm persistence probability was 87.5% and 20.6%, respectively. The only independent risk for aneurysm persistence was the aneurysm severity 1 month after KD onset (χ(2)=80.73, p<10(-3)). Male patients and intravenous γ-immunoglobulin (IVIG) therapy were independent risk factors of initial coronary severity but were not associated with the late coronary outcomes, even in severity stratified subgroups.
CONCLUSIONS:
The coronary severity 1 month after KD onset is most crucial to the late coronary outcomes. Although IVIG use improves the initial severity of coronary lesions, it does not further modify the long-term fate of coronary aneurysms.
AuthorsMing-Tai Lin, Li-Chuan Sun, En-Ting Wu, Jou-Kou Wang, Hung-Chi Lue, Mei-Hwan Wu
JournalArchives of disease in childhood (Arch Dis Child) Vol. 100 Issue 6 Pg. 542-7 (Jun 2015) ISSN: 1468-2044 [Electronic] England
PMID25564534 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightPublished by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Chemical References
  • Immunoglobulins, Intravenous
Topics
  • Aged
  • Coronary Artery Disease (drug therapy, etiology)
  • Coronary Vessels (pathology)
  • Female
  • Humans
  • Immunoglobulins, Intravenous (therapeutic use)
  • Male
  • Mucocutaneous Lymph Node Syndrome (complications, drug therapy)
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

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