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Friedman KG, Gauvreau K, Hamaoka-Okamoto A, Tang A, Berry E, Tremoulet AH, Mahavadi VS, Baker A, deFerranti SD, Fulton DR, Burns JC, Newburger JW. 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:JAHA.116.003289. [PMID: 27633390 PMCID: PMC5079009 DOI: 10.1161/jaha.116.003289] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The natural history of coronary artery aneurysms (CAA) after intravenous immunoglobulin (IVIG) treatment in the United States is not well described. We describe the natural history of CAA in US Kawasaki disease (KD) patients and identify factors associated with major adverse cardiac events (MACE) and CAA regression. Methods and Results We evaluated all KD patients with CAA at 2 centers from 1979 to 2014. Factors associated with CAA regression, maximum CA z‐score over time (zMax), and MACE were analyzed. We performed a matched analysis of treatment effect on likelihood of CAA regression. Of 2860 KD patients, 500 (17%) had CAA, including 90 with CAA z‐score >10. Most (91%) received IVIG within 10 days of illness, 32% received >1 IVIG, and 27% received adjunctive anti‐inflammatory medications. CAA regression occurred in 75%. Lack of CAA regression and higher CAA zMax were associated with earlier era, larger CAA z‐score at diagnosis, and bilateral CAA in univariate and multivariable analyses. MACE occurred in 24 (5%) patients and was associated with higher CAA z‐score at diagnosis and lack of IVIG treatment. In a subset of patients (n=132) matched by age at KD and baseline CAA z‐score, those receiving IVIG plus adjunctive medication had a CAA regression rate of 91% compared with 68% for the 3 other groups (IVIG alone, IVIG ≥2 doses, or IVIG ≥2 doses plus adjunctive medication). Conclusions CAA regression occurred in 75% of patients. CAA z‐score at diagnosis was highly predictive of outcomes, which may be improved by early IVIG treatment and adjunctive therapies.
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Affiliation(s)
- Kevin G Friedman
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberly Gauvreau
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Alexander Tang
- Department of Cardiology, Children's Hospital Boston, Boston, MA
| | - Erika Berry
- Department of Pediatrics, University of California San Diego, La Jolla, CA Rady Children's Hospital San Diego, San Diego, CA
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego, La Jolla, CA Rady Children's Hospital San Diego, San Diego, CA
| | - Vidya S Mahavadi
- Department of Pediatrics, University of California San Diego, La Jolla, CA Rady Children's Hospital San Diego, San Diego, CA
| | - Annette Baker
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Sarah D deFerranti
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David R Fulton
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jane C Burns
- Department of Pediatrics, Harvard Medical School, Boston, MA Rady Children's Hospital San Diego, San Diego, CA
| | - Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
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