Cardiovascular events in Kawasaki Disease not significantly elevated over controls

Image: CC/Wiki. Coronary Aneurysm.

1. Five percent of young adults with childhood Kawasaki Disease had persistent coronary aneurysms. 

2. Similar rates of acute cardiovascular events at age ≥ 15 years were noted in those with and without childhood Kawasaki Disease. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Kawasaki Disease (KD) affects medium-sized blood vessels, is most often seen in children younger than 5 years of age, and is sometimes confused for an infectious process given its common presentation of fever. Accurate diagnosis of KD is crucial, as treatment with intravenous immunoglobulin (IVIG) and aspirin has been shown to reduce the risk of coronary aneurysm development secondary to KD’s inflammatory process. This retrospective study compared patient records from children with and without KD, and examined for differences in cardiovascular events. There was no significant difference in cardiovascular events between the two groups. Despite an overall low rate of persistent aneurysms in the KD group, cases of aneurysm development were more likely associated with an adverse event. Retrospective data was obtained from the Kaiser Permanente database, potentially underestimating adverse event data if patients obtained follow-up care elsewhere. This large study reassures the low risk of cardiovascular events in children treated for KD, though even longer-term follow-up is prudent.

Click to read the study, published today in Pediatrics

Relevant Reading: Long-term Prognosis of Patients with Kawasaki Disease Complicated by Giant Coronary Aneurysms

Study Author, Dr. Jonathan Zaroff, MD, talks to 2 Minute Medicine: Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California

“I am relatively pleased with how [this] paper turned out, especially that we were able to find a relatively large sample size and produce an average follow-up time of 15 years. I think the clinical utility of the study is that it provides reassurance to pediatricians, parents, and children with KD that, with current therapies and a good initial outcome (no persistent aneurysm, which is the norm), “interim” term complication rates appear to be very low. Obviously, this paper doesn’t tell us about risk later in life so I am tempted to take another look at the cohort every 10 years of so.”

In-Depth [retrospective cohort]: This retrospective cohort study enrolled 546 children with known KD at age ≤ 5 years along with 2218 matched controls from the Kaiser Permanente Northern California database. Seventy-nine percent of KD cases were treated with IVIG. The primary analysis used Cox proportional hazards ratios to compare cardiovascular events (acute coronary syndrome, coronary revascularization, heart failure, ventricular arrhythmia, valvular disease, aortic aneurysm, all-cause mortality) at age ≥ 15 years, though secondary analyses also looked at cardiovascular events at younger ages. In the KD group, there were 0.246 events per 1000 person-years compared to 0.217 events per 1000 person-years in those without KD; this was a non-significant difference. This primary analysis included the 2 events in the KD group at ≥ 15 years. Though an additional 3 events at ≤ 15 years were noted in the KD group, the study did not have enough power to interpret this finding. Persistent coronary aneurysms were recorded in 5% of the KD group, and were associated with higher likelihood of cardiovascular event.

More from this author: Hypotonic IVF linked to increased risk of hyponatremia, New risk stratification algorithm suggested for neonatal sepsis, Decreased trainee autonomy suggested with in-hospital intensivist coverage, Decreased incidence of NEC with probiotic supplementation, Increased infections noted with longer duration neonatal PICC placement

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