Long-term changes in coronary artery aneurysms in patients with Kawasaki disease: comparison of therapeutic regimens.
BACKGROUND
There are few studies of the therapeutic regimens for the prevention of stenotic transformation of aneurysms in Kawasaki disease (KD). The aim of this study was to assess the prophylactic effect of combined therapy in the acute stage and convalescent- to chronic-stage against the formation of stenotic lesions.


RESULTS
In 85 patients, 103 giant aneurysms (ANl), 46 medium-sized aneurysms (ANm), and 13 small aneurysms (ANs) were analyzed. With respect to therapy in the acute stage, no localized stenosis of ANl in the left coronary artery was noted in patients who received high-dose gamma globulin therapy (G). For ANm, the group (G) showed a significantly higher regression rate than the aspirin group and steroids group. Furthermore, no coronary artery occlusion/recanalization of ANl occurred with the prophylactic regimen of aspirin and warfarin {aw}. Prophylaxis {aw} and the prophylactic regimen of aspirin alone {a} significantly lowered the incidence compared with either the prophylactic regimen of warfarin {w} or no prophylaxis {n}. However, no significant differences were noted between prophylaxis {w} and {n}.


CONCLUSIONS
High-dose gamma globulin therapy in the acute stage of KD is the first choice for the prevention of stenotic transformation. Prophylaxis {aw} is recommended for ANl.
Onouchi
Zenshiro
Z
Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan. zen@mrj.biglobe.ne.jp
Hamaoka
Kenji
K
Sakata
Koichi
K
Ozawa
Seiichiro
S
Shiraishi
Isao
I
Itoi
Toshiki
T
Kiyosawa
Nobuyuki
N
D000208:Acute Disease; D001241:Aspirin / Q000627:therapeutic use; D003323:Coronary Aneurysm / Q000188:drug therapy* / Q000473:pathology; D023921:Coronary Stenosis / Q000517:prevention & control; D006801:Humans; D008137:Longitudinal Studies; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D014859:Warfarin / Q000627:therapeutic use; D005719:gamma-Globulins / Q000008:administration & dosage* / Q000627:therapeutic use
D005719:gamma-Globulins; D014859:Warfarin; D011239:Prednisolone; D001241:Aspirin