Case–control study of giant coronary aneurysms due to Kawasaki disease: The 19th nationwide survey

Sudo, Daisuke; Monobe, Yoshiro; Yashiro, Mayumi; Sadakane, Atsuko; Uehara, Ritei; Nakamura, Yosikazu

doi:10.1111/j.1442-200x.2010.03161.x

Cited by 34 publications

(32 citation statements)

References 24 publications

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“…Identified risk factors include incomplete presentation, delay in diagnosis/ duration of fever before treatment, male sex, young and older age and IVIG resistance. [6][7][8][15][16][17][18][19][20] Most studies also point to timing of therapy as a critical factor in the development of CA abnormalities. Our study was not designed to assess risk factors for the development of CA abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Preventing Coronary Artery Abnormalities

Dominguez

Anderson

Eladawy³

et al. 2012

Pediatric Infectious Disease Journal

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Section: Discussionmentioning

confidence: 99%

Preventing Coronary Artery Abnormalities

Dominguez

Anderson

Eladawy³

et al. 2012

Pediatric Infectious Disease Journal

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“…33 – 35 To the best of our knowledge, this is the first study dealing not only with giant aneurysms but also with mid- or small-sized aneurysms and dilatations as the primary outcome measure. The finding of a U-shaped effect of patient age on the development of CALs suggests heterogeneity of causative agents or different reactions at different maturity stages of the immune and vascular systems associated with the pathogenesis of damage to coronary arteries in KD.…”

Section: Discussionmentioning

confidence: 99%

Epidemiologic Features and Prognostic Factors of Coronary Artery Lesions Associated With Kawasaki Disease Based on a 13-Year Cohort of Consecutive Cases Identified by Complete Enumeration Surveys in Wakayama, Japan

Kitano

Suzuki

Takeuchi

et al. 2014

Journal of Epidemiology

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BackgroundTo clarify the contribution of patient age to the development of coronary artery lesions (CALs) associated with Kawasaki disease (KD), epidemiologic features and prognostic factors were investigated using hospital-based complete enumeration surveys in a specific area.MethodsConsecutive KD cases identified between October 1999 and September 2012 in Wakayama Prefecture, Japan, were analyzed. The primary outcome measure was the presence/absence of CALs (giant aneurysm, mid- or small-sized aneurysm, and dilatation) on echocardiography 1 month after disease onset. Demographics and medical treatment factors were compared between the patients with and without CALs. Odds ratios (ORs) and 95% confidence intervals (CIs) of explanatory variables (age, gender, and factors related to high-dose intravenous immunoglobulin treatment) for the development of CALs were determined.ResultsThe median age of the 1415 patients (796 males, 619 females) was 25 months after excluding 2 children of foreign residents; 2.2% of the patients had a past history of KD, and 1.8% showed incomplete presentation. CALs were observed in 3.3% (4.0% of males, 2.3% of females; P = 0.080). The ORs of CALs among patients <11 months old (3.0, 95% CI 1.4–6.6) and those >48 months old (3.1, 95% CI 1.5–6.6) were significantly higher than values in 11- to 48-month-olds.ConclusionsThe effect of patient age on the development of CALs was found to be U-shaped, with the bottom at ages 11 to 48 months. This finding was based on a 13-year cohort of consecutive KD cases in a specific area with little selection bias and is consistent with previously reported results.

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“…Recently, the age less than 1 year has been reported to be a significant risk factor for giant coronary aneurysms [15,16], with increased likelihoods also associated with age more than 5 years, especially in males [16]. In the Fig.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of plasma exchange for Kawasaki disease with coronary artery dilatation

et al. 2017

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Background: The treatment of Kawasaki disease is controversial when intravenous immunoglobulin therapy fails, although it typically relies on combinations of prednisolone, infliximab, cyclosporine, and plasma exchange therapy. The goal of the treatment is no longer merely to reduce mortality but also to decrease the sequelae of coronary artery lesions, which are the most common and potentially life-threatening complications. Recently, plasma exchange therapy has been used to treat intravenous immunoglobulin-unresponsive Kawasaki disease with coronary artery lesions. When performed before coronary artery dilatation, the outcomes for plasma exchange are known to be excellent; however, when dilatation is already present, sequelae persist. Methods: Between December 2006 and April 2015, we treated ten patients with Kawasaki disease complicated by coronary artery lesions that received plasma exchange because intravenous immunoglobulin therapy had proven to be ineffective. Here, we retrospectively review the efficacy and safety of plasma exchange therapy in such unresponsive cases against coronary artery lesions in patients with Kawasaki disease when plasma exchange performed after coronary artery dilatation. Results: In nine of the ten patients (90.0%), the body temperature was confirmed to be < 37.5°C at an average of 2.7 ± 1. 4 days after starting plasma exchange. Serum C-reactive protein levels decreased significantly from 9.9 ± 4.9 mg/dL before exchange to 1.9 ± 2.9 mg/dL after exchange (P < 0.05). One year after plasma exchange treatment, the coronary artery lesions had regressed to within normal limits in six of the ten patients. Although lesions remained in three patients, all three of these patients were asymptomatic. In addition, there were no stenosis of the coronary artery in nine of the ten patients. One patient died due to a ruptured giant coronary aneurysm 1 day after starting plasma exchange. Conclusions: In conclusion, plasma exchange may be effective in not only regressing coronary artery lesions but also preventing sequelae in patients with Kawasaki disease when plasma exchange is performed after coronary artery dilatation.

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Case–control study of giant coronary aneurysms due to Kawasaki disease: The 19th nationwide survey

Cited by 34 publications

References 24 publications

Preventing Coronary Artery Abnormalities

Preventing Coronary Artery Abnormalities

Epidemiologic Features and Prognostic Factors of Coronary Artery Lesions Associated With Kawasaki Disease Based on a 13-Year Cohort of Consecutive Cases Identified by Complete Enumeration Surveys in Wakayama, Japan

Efficacy and safety of plasma exchange for Kawasaki disease with coronary artery dilatation

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