Document Type
Article
Publication Date
8-2022
Identifier
DOI: 10.1016/j.cjcpc.2022.05.007; PMCID: PMC10642124
Abstract
BACKGROUND: The impact of adjunctive anti-inflammatory treatment on outcomes for patients with Kawasaki disease (KD) and coronary artery aneurysms (CAAs) is unknown.
METHODS: Using data from the International KD Registry in patients with ≥ medium CAA we evaluate associations of treatment with outcomes and major adverse cardiac events (MACE).
RESULTS: Medium or large CAA was present in 527 (32%) patients. All were treated with intravenous immunoglobulin (IVIG), 70% were male, and the median age was 1.3 years (interquartile range: 0.4-4.0 years). The most common acute therapies included single IVIG alone in 243 (46%), multiple IVIG in 100 (19%), multiple IVIG + corticosteroids in 75 (14%), and multiple IVIG + infliximab + corticosteroids in 44 (8%) patients. Patients who received therapy beyond single IVIG had a larger CA z-score at baseline (P < 0.001) and a higher rate of bilateral CAA (P < 0.001). Compared with IVIG alone, early adjunctive treatments (within 3 days of initial IVIG) were not associated with time to CAA regression or MACE, whereas later adjunctive therapy was associated with MACE and longer time to CAA regression. Patients receiving IVIG plus steroids vs IVIG alone had a trend towards shorter time to CAA regression and lower risk of MACE (P = 0.07). A larger CAA z-score at baseline was the strongest predictor of an increase in the CAA z-score over follow-up, lower likelihood of CAA regression, and higher risk of MACE.
CONCLUSIONS: Persistence of CAA and MACE are more strongly associated with baseline severity CAA than with acute adjuvant anti-inflammatory therapy. Patients who received late adjunctive therapy are at higher risk for worse outcomes.
Journal Title
CJC Pediatr Congenit Heart Dis
Volume
1
Issue
4
First Page
174
Last Page
183
Recommended Citation
Friedman KG, McCrindle BW, Runeckles K, et al. Association of Acute Anti-inflammatory Treatment With Medium-term Outcomes for Coronary Artery Aneurysms in Kawasaki Disease. CJC Pediatr Congenit Heart Dis. 2022;1(4):174-183. Published 2022 Jun 17. doi:10.1016/j.cjcpc.2022.05.007
Comments
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Publisher's Link: https://www.cjcpc.ca/article/S2772-8129(22)00048-3/fulltext