title: Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous γ-immunoglobulin therapy.
abstract: OBJECTIVE
  To explore acute and late coronary outcomes and their risk/modifiers in patients with Kawasaki disease (KD).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  1073 patients with KD identified from a tertiary care medical centre (1980-2012; 8677 patient-years).
  
  
  METHODS
  The acute coronary severities and late outcomes (survival free of coronary aneurysm persistence and ischaemia) were assessed.
  
  
  RESULTS
  Coronary arterial lesions occurred in 40.6% of cases at their acute febrile stages, and persisted beyond 1 month in 196 (18.3%, M/F=138/58) patients: 125 (11.6%) had small aneurysms, 44 (4.1%) had medium aneurysms, and 27 (2.5%) had giant aneurysms. At follow-up (1-46 years), coronary aneurysms persisted in all with giant aneurysms, in 55% of those with medium aneurysms (18% with stenosis), and in 9% of those with small aneurysms. Ischaemia events occurred in 14 patients (M/F=13/1) and caused four deaths. Among the patients with KD with coronary aneurysms, 10-year ischaemia event-free and aneurysm persistence probability was 87.5% and 20.6%, respectively. The only independent risk for aneurysm persistence was the aneurysm severity 1 month after KD onset (χ(2)=80.73, p<10(-3)). Male patients and intravenous γ-immunoglobulin (IVIG) therapy were independent risk factors of initial coronary severity but were not associated with the late coronary outcomes, even in severity stratified subgroups.
  
  
  CONCLUSIONS
  The coronary severity 1 month after KD onset is most crucial to the late coronary outcomes. Although IVIG use improves the initial severity of coronary lesions, it does not further modify the long-term fate of coronary aneurysms.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors.forename: Ming-Tai
authors.initials: MT
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Cardinal Tien General Hospital, Taipei, Taiwan.
authors.forename: Li-Chuan
authors.initials: LC
authors.lastname: Sun
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors.forename: En-Ting
authors.initials: ET
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors.forename: Jou-Kou
authors.initials: JK
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Lue
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors.forename: Mei-Hwan
authors.initials: MH
authors.lastname: Wu
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000209:etiology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: Cardiology; Coronary arterial lesions; Kawasaki disease; Myocardial ischemia; Risk factors