Patients diagnosed with KD between 1990 and 2013 were included. Patients with maximum coronary artery z-scores>5 were classified as having CA
aneurysms. Separate multivariable regression models were used to determine factors associated with CA
aneurysms for those with versus without prompt treatment.
RESULTS: Of 1358 patients included, 83% (n=1126) were treated with
IVIG within 10days and 5% (n=53) developed CA
aneurysms. Patients who had delayed (>10days) or no
IVIG treatment were at increased odds of developing CA
aneurysms (OR: 3.1,95% CI: 1.9-5.1, p<0.001). For patients with prompt treatment with
IVIG, factors associated with increased odds of CA
aneurysms were: longer duration of
fever prior to treatment (OR: 1.2/day, p=0.04), age<1year (OR: 3.9, p=0.001), higher pre-
IVIG white blood cell count (OR: 1.05/×109/L, p=0.007), lower
hemoglobin (OR: 1.4/g/L, p=0.004) and non-response to initial
IVIG treatment (OR: 2.5, p<0.001). For patients with delayed or no treatment, factors associated with increased odds of CA
aneurysms were: males (OR: 5.4, p=0.009), age<1year (OR: 29.9, p<0.001), and higher platelet count (OR: 1.4/100×1012/L, p=0.001).
Delayed treatment with
IVIG did not reduce the risk of CA
aneurysms (OR: 1.9, p=0.28), and total duration of
fever was not associated with CA
aneurysms for this group (OR: 1.04/day, p=0.16).
CONCLUSIONS: Factors associated with the development of CA
aneurysms are generally similar for those treated promptly versus those with delayed or no treatment. For those with delayed diagnosis, treatment with
IVIG does not appear to be effective to prevent CA
aneurysms.