TY - JOUR
T1 - Medium-term complications associated with coronary artery aneurysms after kawasaki disease
T2 - A study from the international kawasaki disease registry
AU - International Kawasaki Disease Registry
AU - McCrindle, Brian W.
AU - Manlhiot, Cedric
AU - Newburger, Jane W.
AU - Harahsheh, Ashraf S.
AU - Giglia, Therese M.
AU - Dallaire, Frederic
AU - Friedman, Kevin
AU - Low, Tisiana
AU - Runeckles, Kyle
AU - Mathew, Mathew
AU - Mackie, Andrew S.
AU - Choueiter, Nadine F.
AU - Jone, Pei Ni
AU - Kutty, Shelby
AU - Yetman, Anji T.
AU - Raghuveer, Geetha
AU - Pahl, Elfriede
AU - Norozi, Kambiz
AU - McHugh, Kimberly E.
AU - Li, Jennifer S.
AU - De Ferranti, Sarah D.
AU - Dahdah, Nagib
N1 - Funding Information:
for the data coordinating center was partially provided by the CIBC World Market Chair in Child Health Research (Brian McCrindle) and the Labatt Family Heart Centre at SickKids Hospital. Additional local funding for participation in the IKDR was provided by les Fonds BoBeau Coeur of the Ste-Justine Hospital Foundation (Nagib Dahdah), the McCance Family Foundation (Jane Newburger), the Vella Fund (Jane Newburger), and the Children’s Health Foundation of London, Ontario (Kambiz Norozi).
Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020/8/4
Y1 - 2020/8/4
N2 - BACKGROUND: Coronary artery aneurysms (CAAs) may occur after Kawasaki disease (KD) and lead to important morbidity and mortality. As CAA in patients with KD are rare and heterogeneous lesions, prognostication and risk stratification are difficult. We sought to derive the cumulative risk and associated factors for cardiovascular complications in patients with CAAs after KD. METHODS AND RESULTS: A 34-institution international registry of 1651 patients with KD who had CAAs (maximum CAA Z score ≥2.5) was used. Time-to-event analyses were performed using the Kaplan–Meier method and Cox proportional hazard models for risk factor analysis. In patients with CAA Z scores ≥10, the cumulative incidence of luminal narrowing (>50% of lumen diameter), coronary artery thrombosis, and composite major adverse cardiovascular complications at 10 years was 20±3%, 18±2%, and 14±2%, respectively. No complications were observed in patients with a CAA Z score <10. Higher CAA Z score and a greater number of coronary artery branches affected were associated with increased risk of all types of complications. At 10 years, normalization of luminal diameter was noted in 99±4% of patients with small (2.5≤Z<5.0), 92±1% with medium (5.0≤Z<10), and 57±3% with large CAAs (Z≥10). CAAs in the left anterior descending and circumflex coronary artery branches were more likely to normalize. Risk factor analysis of coronary artery branch level outcomes was performed with a total of 893 affected branches with Z score ≥10 in 440 patients. In multivariable regression models, hazards of luminal narrowing and thrombosis were higher for patients with CAAs of the right coronary artery and left anterior descending branches, those with CAAs that had complex architecture (other than isolated aneurysms), and those with CAAs with Z scores ≥20. CONCLUSIONS: For patients with CAA after KD, medium-term risk of complications is confined to those with maximum CAA Z scores ≥10. Further risk stratification and close follow-up, including advanced imaging, in patients with large CAAs is warranted.
AB - BACKGROUND: Coronary artery aneurysms (CAAs) may occur after Kawasaki disease (KD) and lead to important morbidity and mortality. As CAA in patients with KD are rare and heterogeneous lesions, prognostication and risk stratification are difficult. We sought to derive the cumulative risk and associated factors for cardiovascular complications in patients with CAAs after KD. METHODS AND RESULTS: A 34-institution international registry of 1651 patients with KD who had CAAs (maximum CAA Z score ≥2.5) was used. Time-to-event analyses were performed using the Kaplan–Meier method and Cox proportional hazard models for risk factor analysis. In patients with CAA Z scores ≥10, the cumulative incidence of luminal narrowing (>50% of lumen diameter), coronary artery thrombosis, and composite major adverse cardiovascular complications at 10 years was 20±3%, 18±2%, and 14±2%, respectively. No complications were observed in patients with a CAA Z score <10. Higher CAA Z score and a greater number of coronary artery branches affected were associated with increased risk of all types of complications. At 10 years, normalization of luminal diameter was noted in 99±4% of patients with small (2.5≤Z<5.0), 92±1% with medium (5.0≤Z<10), and 57±3% with large CAAs (Z≥10). CAAs in the left anterior descending and circumflex coronary artery branches were more likely to normalize. Risk factor analysis of coronary artery branch level outcomes was performed with a total of 893 affected branches with Z score ≥10 in 440 patients. In multivariable regression models, hazards of luminal narrowing and thrombosis were higher for patients with CAAs of the right coronary artery and left anterior descending branches, those with CAAs that had complex architecture (other than isolated aneurysms), and those with CAAs with Z scores ≥20. CONCLUSIONS: For patients with CAA after KD, medium-term risk of complications is confined to those with maximum CAA Z scores ≥10. Further risk stratification and close follow-up, including advanced imaging, in patients with large CAAs is warranted.
KW - Cardiovascular outcomes
KW - Coronary artery
KW - Kawasaki disease
KW - Risk factors
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U2 - 10.1161/JAHA.119.016440
DO - 10.1161/JAHA.119.016440
M3 - Article
C2 - 32750313
AN - SCOPUS:85089132497
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e016440
ER -