Prognosis of coronary arterial lesions in Kawasaki disease treated without intravenous immunoglobulin.
From 1981 to 1989, a total of 86 consecutive patients with definite Kawasaki disease who received aspirin but not intravenous immunoglobulin (IVIG) therapy during the acute stage were studied. Thirty-eight of them (44%) had coronary arterial lesion (CAL) on initial two dimensional echocardiograms. Of them, 21 (56%) had ectatic coronary changes, 13 (34%) had small to large coronary aneurysms (diameter < or = 8 mm) and 4 (10%), giant coronary aneurysms (diameter > 8 mm). Patients with CAL had, in the acute stage, a longer duration of fever (p < 0.01), higher maximum platelet counts (p < 0.05) and a higher one-hour erythrocyte sedimentation rate (< 0.01) than those without. Males were associated with a higher incidence of aneurysmal dilatation of the CAL. By actuarial event-free analysis, more than half of the ectatic coronary lesions regressed within two months of onset, and 86% became normal on echocardiograms within a two-year follow-up period. Ectatic lesions had a significantly higher chance of regression than aneurysmal lesions (p < 0.01). Furthermore, none of the giant aneurysms regressed (p < 0.05, as compared with those coronary aneurysms smaller than 8 mm in diameter). It was concluded that coronary arterial lesions occurred in a substantial number of Chinese children with Kawasaki disease who received only aspirin therapy. Regression of the lesions was related to their size and morphology.
Tzen
K T
KT
Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Wu
M H
MH
Wang
J K
JK
Lue
H C
HC
Lee
C Y
CY
Chien
S C
SC
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000209:etiology*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000628:therapy*; D011379:Prognosis
D016756:Immunoglobulins, Intravenous