The following is a summary of “Outcomes Associated With Giant Coronary Artery Aneurysms After Kawasaki Disease: A Single-Center United States Experience,” published in the June 2024 issue of Pediatrics by Elias et al.
This retrospective study aimed to comprehensively evaluate the extended outcomes of patients diagnosed with Kawasaki disease (KD) and subsequent giant coronary artery aneurysms (CAA) at a prominent US center. Spanning from 1989 to 2023, the study cohort comprised 60 patients, predominantly male (71.7%), with a median age at KD diagnosis of 0.9 years (range 0.2-13.3 years). These patients were meticulously followed over a median period of 11 years, with some individuals monitored up to 34.5 years.
During the follow-up period, significant findings emerged regarding major adverse cardiac events (MACE), which occurred in 13 patients (21.7%) at a median time of 1.4 years following KD diagnosis, with occurrences ranging widely from 0.04 to 22.6 years post-diagnosis. Notably, the cumulative rates of remaining free from MACE at 10, 20, and 30 years were reported as 75%, 75%, and 60%, respectively. Of particular clinical significance was the observation that patients presenting with maximal coronary artery (CA) z-scores of ≥20 or bilateral CAAs demonstrated a notably heightened susceptibility to MACE.
Throughout the study, approximately 26.7% of the identified CAAs demonstrated spontaneous regression to normal luminal diameter, occurring at a median time of 3.6 years following diagnosis, ranging from 0.6 to 12.0 years. The likelihood of CA regression to normal dimensions persisted over the long term, with rates documented at 36% at 10 years, increasing to 46% by both the 20- and 30-year marks.
In conclusion, the study underscores the enduring impact of KD-associated giant CAAs on patient outcomes over three decades of observation. Despite substantial regression observed in a notable portion of cases, nearly 22% of patients experienced MACE, particularly those with more severe initial presentations. These findings emphasize the critical need for ongoing and vigilant cardiac monitoring in individuals with a history of KD and giant CAAs, highlighting the imperative role of long-term follow-up care in mitigating potential cardiac complications.
Source: sciencedirect.com/science/article/abs/pii/S0022347624002488
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