Korean Circ J.  2017 Jul;47(4):516-522. 10.4070/kcj.2016.0163.

Long-Term Prognosis for Patients with Kawasaki Disease Complicated by Large Coronary Aneurysm (diameter ≥6 mm)

• Bang JS
• Kim GB
• Kwon BS
• Song MK
• An HS
• Song YW
• Bae EJ
• Noh CI

• KMID: 2392890
• DOI: http://doi.org/10.4070/kcj.2016.0163

Abstract

BACKGROUND AND OBJECTIVES
Some patients with Kawasaki disease (KD) develop large coronary aneurysms and subsequent coronary stenosis or obstruction, leading to ischemic heart disease. This study examined the long-term outcomes of patients with KD complicated by large coronary aneurysms.
SUBJECTS AND METHODS
The medical records of 71 patients (53 men and 18 women) diagnosed with large coronary aneurysms (diameter ≥6 mm) between December 1986 and December 2013 were retrospectively reviewed from our institutional database.
RESULTS
The mean age at onset was 4.6±3.3 years, and the mean follow-up duration was 12.5±6.9 years. Maximum coronary artery internal diameter ranged from 6.1 to 25 mm. Giant coronary aneurysms occurred in 48 patients and coronary aneurysms 6-8 mm in diameter developed in 23 patients. Coronary stenosis and/or complete occlusion occurred in 30 patients (42.3%). Catheter and/or surgical interventions (mean: 1.5 interventions, range: 1-5 interventions) were performed in 20 patients (28.2%), 9 months to 18 years after KD onset, resulting in 33.7% cumulative coronary intervention rates at 20 years after onset. There were no differences in cumulative coronary intervention rates between two coronary aneurysm groups (6-8 mm vs. ≥8 mm). Myocardial infarction occurred in 7 patients with a giant aneurysm and there was one death.
CONCLUSIONS
Long-term survival of patients with KD complicated by large coronary aneurysm was good even though 28.2% of patients underwent multiple catheter or surgical interventions. Careful follow-up is also necessary in KD patients with coronary aneurysms 6-8 mm in diameter, such as those with giant aneurysms.

Keyword

Mucocutaneous lymph node syndrome; Coronary aneurysm; Myocardial infarction; Prognosis

MeSH Terms

Age of Onset
Aneurysm
Catheters
Coronary Aneurysm*
Coronary Stenosis
Coronary Vessels
Follow-Up Studies
Humans
Male
Medical Records
Mucocutaneous Lymph Node Syndrome*
Myocardial Infarction
Myocardial Ischemia
Prognosis*
Retrospective Studies

Figure

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  Fig. 1 Kaplan-Meier actuarial freedom from cardiac events. (A) Freedom from any intervention between coronary aneurysm size (6-8 mm vs. ≥8 mm). Trans-catheter and/or surgical coronary interventions were performed in 20 patients, resulting in a 33.7% cumulative coronary intervention rate at 20 years after KD onset. There were no differences in cumulative coronary intervention rates between two coronary aneurysm groups (p=0.148). (B) Freedom from myocardial infarction. The median elapsed time from KD onset to myocardial infarction was 3.0 months (range: 0.5-31.2 months). Cumulative survival rate was 89.6% and most myocardial infarction occurred in the first year after onset of giant coronary aneurysm. KD: Kawasaki disease.

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