A Retrospective Study On Occurrence And Outcome Of Coronary Artery Lesions In Patients With Kawasaki Disease

PartⅠOccurrence of coronary artery lesions secondary to kawasaki disease and its risk factorsObjective To explore the occurrence of coronary artery lesion (CAL) secondary to Kawasaki disease (KD) and its risk factors.Methods The clinical records of 1148 pediatric patients with Kawasaki disease and echocardiographic data admitted to our hospital from January 1985 to December 2009 were analyzed retrospectively. Prevalence of CAL was calculated, and the risk factors for CAL were measured by both single factor analysis and multivariate logistic regression analysis.Results (1) 242 cases complicated with CAL and the prevalence of CAL was 21.1% (242/1148). Coronary artery ectasia and small coronary aneurysm accounted for 79.8%(193/242) of total CALs with prevalence of 16.8%(193/1148). Moderate coronary aneurysm accounted for 16.1%(39/242) with prevalence of 3.4% (39/1148). And giant coronary aneurysm accounted for 4.1%(10/242) with prevalence of 0.9%(10/1148). CAL occurred in single, double, three and four branchs were observed in 48.8%(118/242),28.5%(69/242),12.0%(29/242), and 10.7%(26/242) respectively. Left main trunk, left anterior descending branch, left circumflex branch and right coronary artery lesions accounted for 46.3%(207/447), 17.9%(80/447),6.3%(28/447) and 29.5%(132/447) of all the branchs involved respectively.(2) Univariate analysis revealed that the occurrence of CAL was associated with male, age of onset<1 year old, incomplete Kawasaki disease, refractory Kawasaki disease, long fever time, late treatment time of intravenous gamma immunoglobulin (IVIG), lower hemoglobin (HB), rapid erythrocyte sedimentation rate (ESR) and elevated C reactive protein (CRP) (P<0.05). Multivariate Logistic regression analysis implied that age<1 year old, long-lasting fever (>10 d) and elevated CRP were independently associated with CAL secondary to Kawasaki disease (P<0.05).(3) Single factor analysis showed that male, incomplete Kawasaki disease, refractory Kawasaki disease, long-lasting fever time, late treatment time of IVIG, abnormal Electrocardiogram(ECG) and lower HB were associated with medium-giant coronary aneurysm (P<0.05). Multivariate logistic regression analysis implied that long-lasting fever (>10 d) and lower HB were independently correlated with medium-giant coronary aneurysm (P<0.05).Conclusions(1) The total prevalence of CAL in Kawasaki disease is 21.1%. The medium coronary aneurysm and giant coronary aneurysm were seen in 4.3% and 0.9% of the patients respectively.(2) The most common type of CAL in Kawasaki disease is single branch lesions. The most frequently involved branch is Left main trunk followed by right coronary artery and left anterior descending branch, while left circumflex branch is relatively low.(3) Age<1 year old, long-lasting fever (>10d) and elevated CRP are the ind-ependent risk factors of CAL in Kawasaki disease, and long-lasting fever (>10d), lower HB are the independent risk factors of medium-giant coronary aneurysm.Part IIOutcome of coronary artery lesion in patients with Kawasaki disease and its risk factorsObjective To evaluate the outcome of coronary artery lesion (CAL) in patients with Kawasaki disease (KD) and its risk factors.Methods 218 patients with CAL met the inclusion criteria were divided into 3 groups, including the coronary artery ectasia and small coronary artery aneurysm group (Dil-ANs group), medium artery aneurysm group (ANm group) and giant artery aneurysm group (ANg group), based on the severity of CAL. Outcome of the three groups were investigated and compared at the time point of 3,6,12,24,36 and 60 month. The factors associated with the prognosis of CAL within 1 year of the onset of KD were analysed by univariate analysis followed by multivariate logistic regression analysis.Results (1) Recovery of CAL was observed in 65.3% of Dil-ANs group,5.7% of ANm group, and 0 of ANg group at 3-month follow-up. It was 76.8%,8.7% and 0 at 6-month; 85.6%,21.8% and 0 at 1-year; 91.7%,50.3% and 0 at 2-year; 95.4%, 50.3% and 0 at 3-year; and 97.7%,80.1% and 0 at 5-year follow up. Coronary artery intraluminal thrombus was found by echocardiography in 5 cases, while no obvious coronary stenosis, ischemic heart disease, myocardial infarction or death cases occured during follow-up.(2) Univariate analysis showed that fever lasted> 10 days, late treatment time of IVIG, resistant to IVIG, hormone therapy, diameter of coronary artery aneurysm(?)4mm, multiple branchs involved, lower HB, rapid ESR and lower ALB were significantly related to the outcome of CAL within 1 year (P< 0.05). Multivariate Logistic regression analysis identified that fever lasting>10 days, the diameter of coronary artery aneurysms≥4mm and multiple branchs involved as independent risk factors of the outcome of CAL within 1 year after onset (P< 0.05).Conclusions(1) Coronary artery ectasia and small coronary and medium artery aneurysms have a better prognosis, while giant coronary aneurysm is difficult to recover.(2) Fever lasting>10 days, the diameter of coronary artery aneurysms >4mm and multiple branchs involved are independent risk factors of prognosis of CAL within 1 year after onset of Kawasaki disease.