Long-term Cardiovascular Outcomes in Survivors of Kawasaki Disease

Abstract

BACKGROUND AND OBJECTIVE: Kawasaki disease (KD) may result in coronary aneurysm formation, but there is incomplete knowledge regarding its long-term effects. Our objective was to quantify the longer-term rates of adverse cardiac events in a modern North American KD cohort. METHODS: Using the Kaiser Permanente Northern California population, we performed a retrospective cohort study in patients with a history of KD versus matched patients without KD. Chart review was used to confirm the diagnosis of KD and all outcomes of interest, including acute coronary syndrome, coronary revascularization, heart failure, ventricular arrhythmia, valve disease, aortic aneurysm, and all-cause mortality. All outcomes occurring at age ≥15 years were included in the primary analysis. Outcome rates were compared between the 2 groups by using Cox proportional hazards analysis. RESULTS: The study included 546 KD patients and 2218 matched patients without KD. Seventy-nine percent of the KD patients received intravenous immunoglobulin and 5% had persistent coronary aneurysm. The average follow-up time was 14.9 years. Only 2 KD patients experienced outcomes after age 15 (0.246 events per 1000 person-years) compared with 7 events in the non-KD group (0.217 events per 1000 person-years), a nonsignificant difference (hazard ratio: 0.81; 95% confidence interval: 0.16–4.0). Within the KD subgroup, persistent coronary aneurysm predicted the occurrence of adverse events (P = .007). CONCLUSIONS: This is the largest US study of longer-term cardiac outcomes after KD and reveals a low rate of adverse cardiovascular events through age 21. Additional validation studies, including studies with longer-term follow-up, should be performed.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

“…Although systematic long-term data are not available, evidence suggests that these patients are not at increased risk of late mortality attributable to CVD compared with the general population. [309][310][311][312][313] The association with late events is limited to rare case reports. 314,315 For patients defined as having an aneurysm of any size noted at any assessment, ongoing cardiology follow-up is recommended.…”

Uso oportuno de inmunoglobulinas intravenosas y riesgo de alteraciones coronarias en pacientes con Enfermedad de Kawasaki

“…Nathan Pulido [2][3] Estos cambios vasculares inflamatorios agudos pueden evolucionar a compromiso coronario, miocarditis y pericarditis, entre otros. La afección central y más relevante ocurre en las arterias coronarias por inflamación de la capa media, con edema y necrosis del músculo liso, favoreciendo la dilatación y formación de aneurismas.…”

“…La afección central y más relevante ocurre en las arterias coronarias por inflamación de la capa media, con edema y necrosis del músculo liso, favoreciendo la dilatación y formación de aneurismas. [1][2] En etapas más avanzadas puede desarrollarse estenosis y oclusión arterial por trombosis sobre-agregada, llevando a infarto agudo al miocardio y potencial muerte súbita. 3 La incidencia tiene grandes variaciones geográficas y ét-nicas.…”

Atopic Predilection among Kawasaki Disease Patients: A Cross-Sectional Study of 1,187,757 Teenagers

“…However, efforts to identify an infectious agent with conventional bacterial and viral cultures or serological methods, as well as with animal inoculation, have failed [4,5]. It may be that KD results from an immunologic response that is triggered by any of several different and yet unidentified microbial agents [6,7,8,9].…”