Study on Cardiovascular Diseases
Middle and long-term follow-up of 101 children with giant coronary artery aneurysm of Kawasaki disease
Xiong Yi, Zhang Yonglan, Du Zhongdong
Published 2021-02-02
Cite as Chin J Pediatr, 2021, 59(2): 101-106. DOI: 10.3760/cma.j.cn112140-20201124-01052
Abstract
ObjectiveTo summarize the clinical features, middle-and long-term prognosis of Kawasaki disease (KD) with giant coronary artery aneurysm (GCAA).
MethodsIn this retrospective cohort study, a cross-sectional analysis was conducted on 101 KD children with GCAA in the KD with GCAA database established by Beijing Children′s Hospital, Capital Medical University in 2004. GCAA was diagnosed as coronary artery absolute lumen diameter ≥8.0 mm. All patients were followed up regularly. The endpoint was the time of last follow-up or the death time. T test or χ2 test was used for comparison between groups.
ResultsA total of 101 KD children with GCAA were enrolled, including 82 males (81.2%) and 19 females (18.8%). The age of disease onset was 2.5 (1.0, 4.5) years. The follow-up duration was 4.5 (2.7, 7.5) years, with a longest of 19 years. All children received routine treatment with aspirin and warfarin, and clopidogrel was added in severe cases. At the end of follow-up, 13 cases (12.9%) had cardiac enlargement, 11 cases (10.9%) developed heart failure, 13 cases (12.9%) experienced myocardial infarction, 2 cases (2.0%) underwent coronary artery bypass graft and 6 cases (5.9%) died. A total of 170 coronary arteries were involved, including 24 (14.1%) GCAAs on the main trunk of left coronary artery, 10 (5.9%) GCAAs on left circumflex, 57 (33.5%) GCAAs on left anterior descending, 78 (45.9%) GCAAs on the middle segments of right coronary artery, and 1 (0.6%) GCAA in the distal segments of right coronary artery. Eleven cases (10.9%) recovered with the coronary artery absolute lumen diameter of all GCAAs below 4.0 mm. Among 170 branches with GCAAs, 28 (16.5%) regressed below 4.0 mm. No significant difference was found in the regression rates between right and left GCAA (18.7% (17/91) vs. 13.9% (11/79), χ²=2.473, P=0.116). There was no statistically significant difference in retraction between unilateral GCAA and bilateral GCAA (16.1% (9/56) vs. 4.4% (2/45), χ2=2.381, P=0.123).
ConclusionsGCAA of KD occurred more common in the middle segments of right and left anterior descending coronary arteries. The incidence of adverse cardiac events and the mortality rate in children with GCAA complicated with KD was high. Their long-term prognosis was poor.
Key words:
Mucocutaneous lymph node syndrome; Coronary aneurysm; Prognosis
Contributor Information
Xiong Yi
Department of Cardiology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
Zhang Yonglan
Department of Cardiology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
Du Zhongdong
Department of Cardiology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
