Miscellaneous
Comparison of Factors Associated With Coronary Artery Dilation Only Versus Coronary Artery Aneurysms in Patients With Kawasaki Disease

Presented at the IX International Kawasaki Disease Symposium (Taipei, Taiwan) 2008, April 10–12.
https://doi.org/10.1016/j.amjcard.2009.07.062Get rights and content

We sought to determine whether differences exist in the factors associated with transient coronary artery (CA) dilation only compared to CA aneurysms after Kawasaki disease (KD). We reviewed all patients with KD assessed and treated at a single tertiary institution from January 1990 to April 2007. Of 1,374 patients (63% men) with KD, 1,108 (81%) had no CA abnormalities; 180 (13%) had CA dilation only, and 86 (6%) had CA aneurysms. The factors associated with any CA abnormality included male gender (odds ratio [OR] 1.8, p <0.001), lower albumin (OR per 1 g/dl, 1.07; p < 0.001), lower hemoglobin (OR per 10 g/dl; 1.02, p = 0.008), diagnosed outside of the 1 to 9-year-age range (OR for <1 year old, 1.5; p = 0.04; OR for >9 years old, 1.9, p = 0.03), longer duration of fever before treatment (OR per day, 1.05, p = 0.002), greater platelet count (OR per 10 × 109/L, 1.14, p = 0.008), and nonresponse to initial intravenous immunoglobulin treatment (OR 2.4, p <0.001). Only age at diagnosis, duration of fever before treatment, greater platelet count, and nonresponse to initial intravenous immunoglobulin discriminated between CA dilation only versus CA aneurysms (c-statistic, 0.80, p <0.001). In conclusion, CA dilation only and CA aneurysms differ only in the total duration of inflammation, as measured by the number of days from fever onset to defervescence.

Section snippets

Methods

All patients with KD diagnosed or referred to the Hospital for Sick Children (Toronto, Ontario, Canada) from January 1990 to April 2007 were included. The institutional research ethics board approved the present study, and the requirement for individual patient consent was waived because it was a retrospective study. The records were reviewed for patient demographics, medical history, clinical characteristics at presentation, laboratory investigation findings, medical management, and CA

Results

A total of 1,374 patients (63% men) with KD were diagnosed or referred to the Hospital for Sick Children during the study period. According to our definition, 1,108 patients (81%) had no CA abnormalities, 180 (13%) had CA dilation only, and 86 (6%) had CA aneurysms after KD. The median age at diagnosis was 3.1 years (range 0.2–17.7), with 16% of patients <1 year of age and 6% >9 years of age. A complete presentation (fever ≥5 days and ≥4 classic KD clinical signs) at diagnosis was seen in 75%

Discussion

Our results have delineated the differences in the factors associated with CA dilation only versus CA aneurysms and suggest that CA dilation only and CA aneurysms are part of the same inflammatory process. Previous studies have either considered all CA abnormalities as a single group or have focused solely on identifying the risk factors for giant aneurysms.6, 15 This distinction is important, because it might have implications for the potential for aneurysm regression and long-term cardiac

References (27)

  • E.D. Belay et al.

    Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994–2003

    Pediatr Infect Dis J

    (2006)
  • V.E. Honkanen et al.

    Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease

    Pediatr Cardiol

    (2003)
  • Y. Morikawa et al.

    Coronary risks after high-dose gamma-globulin in children with Kawasaki disease

    Pediatr Int

    (2000)
  • Cited by (53)

    • Kawasaki disease: The phenomenon of thrombotic coronary and vascular aneurysms in the young and adults-a japanese perspective

      2018, Cardiovascular Thrombus: From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions
    • Kawasaki Disease

      2017, The Heart in Rheumatic, Autoimmune and Inflammatory Diseases: Pathophysiology, Clinical Aspects and Therapeutic Approaches
    • Variability in Response to Intravenous Immunoglobulin in the Treatment of Kawasaki Disease

      2016, Journal of Pediatrics
      Citation Excerpt :

      Previous reports have analyzed clinical factors and laboratory markers as predictors of risk for development of coronary artery abnormalities in KD. Of these risk factors identified, nonresponsiveness to IVIG is the most commonly used target because it is such a strong risk factor for developing coronary artery abnormalities and it provides a platform for discussing second-line treatment options.1,11,15-19 In our study, we added temperature profiles to further stratify risk in nonresponsive patients and identified complete nonresponders as a greater-risk group for developing coronary artery aneurysms than partial nonresponders.

    View all citing articles on Scopus

    Supported in part by the Canadian Imperial Bank of Commerce (CIBC) World Markets Children's Miracle Foundation (Toronto, Ontario, Canada).

    View full text