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.
Coronary Artery Aneurysms in Kawasaki Disease: Risk Factors for Progressive Disease and Adverse Cardiac Events in the US Population
K. Friedman,K. Gauvreau,Akiko Hamaoka-Okamoto,A. Tang,Erika K Berry,A. Tremoulet,Vidya S Mahavadi,A. Baker,Sarah Deferranti,D. Fulton,J. Burns,J. Newburger
Published 2016 in Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease
ABSTRACT
PUBLICATION RECORD
- Publication year
2016
- Venue
Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease
- Publication date
2016-09-01
- Fields of study
Medicine
- Identifiers
- External record
- Source metadata
Semantic Scholar, PubMed
CITATION MAP
EXTRACTION MAP
CLAIMS
CONCEPTS
- adjunctive anti-inflammatory medications
Additional anti-inflammatory drugs given alongside intravenous immunoglobulin in some patients.
Aliases: adjunctive medications, adjunctive anti-inflammatory therapy
- caa regression
Follow-up reduction or resolution of coronary artery aneurysm abnormality on imaging.
Aliases: regression of CAA
- coronary artery aneurysms
Abnormal dilatations of the coronary arteries identified in children with Kawasaki disease in this cohort.
Aliases: CAA
- coronary artery z-score
A body-size standardized measure used to quantify coronary artery aneurysm size at diagnosis and during follow-up.
Aliases: CA z-score, z-score
- intravenous immunoglobulin
IVIG therapy administered to patients as the main acute treatment in the cohort.
Aliases: IVIG
- kawasaki disease
The pediatric vasculitis population studied for coronary artery aneurysm outcomes and treatment response.
Aliases: KD
- major adverse cardiac events
A composite of serious cardiac outcomes tracked during follow-up in patients with coronary artery aneurysms.
Aliases: MACE
REFERENCES
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