Masaru Miura1,2, Tohru Kobayashi3, Tetsuji Kaneko2, Mamoru Ayusawa4, Ryuji Fukazawa5, Naoya Fukushima1, Shigeto Fuse6, Kenji Hamaoka7, Keiichi Hirono8, Taichi Kato9, Yoshihide Mitani10, Seiichi Sato11, Shinya Shimoyama12, Junko Shiono13, Kenji Suda14, Hiroshi Suzuki15, Jun Maeda16, Kenji Waki17, Hitoshi Kato3, Tsutomu Saji18, Hiroyuki Yamagishi16, Aya Ozeki2, Masako Tomotsune2, Makiko Yoshida2, Yohei Akazawa19, Kentaro Aso20, Shouzaburoh Doi21, Yoshi Fukasawa9, Kenji Furuno22, Yasunobu Hayabuchi23, Miyuki Hayashi5, Takafumi Honda24, Norihisa Horita25, Kazuyuki Ikeda7, Masahiro Ishii26, Satoru Iwashima27, Masahiro Kamada28, Masahide Kaneko3, Hiroshi Katyama29, Yoichi Kawamura30, Atushi Kitagawa26, Akiko Komori4, Kenji Kuraishi31, Hiroshi Masuda3, Shinichi Matsuda32, Satoshi Matsuzaki19, Sayaka Mii33, Tomoyuki Miyamoto34, Yuji Moritou28, Noriko Motoki19, Kiyoshi Nagumo35, Tsuneyuki Nakamura36, Eiki Nishihara31, Yuichi Nomura37, Shohei Ogata26, Hiroyuki Ohashi10, Kenichi Okumura29, Daisuke Omori38, Tetsuya Sano39, Eisuke Suganuma32, Tsutomu Takahashi40, Shinichi Takatsuki18, Atsuhito Takeda41, Masaru Terai24, Manatomo Toyono42, Kenichi Watanabe15, Makoto Watanabe5, Masaki Yamamoto43, Kenichiro Yamamura44. 1. Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 2. Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 3. Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan. 4. Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan. 5. Department of Pediatrics, Nippon Medical School, Tokyo, Japan. 6. Department of Pediatrics, NTT Sapporo Medical Center, Hokkaido, Japan. 7. Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 8. Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan. 9. Division of Clinical Research Planning, Department of Development Strategy, Center for Department of Pediatrics, Nagoya University Hospital, Aichi, Japan. 10. Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan. 11. Department of Pediatrics, Niigata City General Hospital, Niigata, Japan. 12. Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan. 13. Department of Pediatric Cardiology, Ibaraki Children's Hospital, Ibaraki, Japan. 14. Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan. 15. Department of Pediatrics, Niigata University, Niigata, Japan. 16. Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan. 17. Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan. 18. Department of Pediatrics, Toho University Medical Center Omori Hospital, Tokyo, Japan. 19. Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan. 20. Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan. 21. Department of Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 22. Department of General Pediatrics & Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan. 23. Department of Pediatrics, Tokushima University, Tokushima, Japan. 24. Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan. 25. Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan. 26. Department of Pediatrics, Kitasato University, Kanagawa, Japan. 27. Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan. 28. Department of Pediatrics, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 29. Department of Pediatrics, Osaka Medical College, Osaka, Japan. 30. Department of Pediatrics, National Defense Medical College, Saitama, Japan. 31. Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan. 32. Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan. 33. Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Aichi, Japan. 34. Department of Pediatrics, Yokosuka General Hospital Uwamachi, Kanagawa, Japan. 35. Department of Pediatrics, Teine Keijinkai Hospital, Hokkaido, Japan. 36. Department of Pediatrics, Kanazawa Medical University, Ishikawa, Japan. 37. Department of Pediatrics, Kagoshima University, Kagoshima, Japan. 38. Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan. 39. Department of Pediatrics, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan. 40. Department of Pediatrics, Saiseikai Utsunomiya Hospital, Tochigi, Japan. 41. Department of Pediatrics, Hokkaido University Hospital, Hokkaido, Japan. 42. Department of Pediatrics, Akita University, Akita, Japan. 43. Department of Pediatrics, Kochi University, Kochi, Japan. 44. Department of Pediatrics, Kyushu University, Fukuoka, Japan.
Abstract
Importance: Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). Objective: To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. Design, Setting, and Participants: This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. Main Outcomes and Measures: The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score, ≥5 to <10; actual internal diameter, <8 mm), and large (z score, ≥10 or ≥8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. Results: Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52% in men (P < .001) and 100%, 100%, and 75% in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100%, 96%, and 79% in patients who were not resistant to IVIG therapy (P < .001) and 100%, 96%, and 51% in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95% CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95% CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95% CI, 1.4-3.6) were significantly associated with CE. Conclusions and Relevance: Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.
Importance: Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). Objective: To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. Design, Setting, and Participants: This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. Main Outcomes and Measures: The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score, ≥5 to <10; actual internal diameter, <8 mm), and large (z score, ≥10 or ≥8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. Results: Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52% in men (P < .001) and 100%, 100%, and 75% in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100%, 96%, and 79% in patients who were not resistant to IVIG therapy (P < .001) and 100%, 96%, and 51% in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95% CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95% CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95% CI, 1.4-3.6) were significantly associated with CE. Conclusions and Relevance: Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.
Authors: Brian W McCrindle; Anne H Rowley; Jane W Newburger; Jane C Burns; Anne F Bolger; Michael Gewitz; Annette L Baker; Mary Anne Jackson; Masato Takahashi; Pinak B Shah; Tohru Kobayashi; Mei-Hwan Wu; Tsutomu T Saji; Elfriede Pahl Journal: Circulation Date: 2017-03-29 Impact factor: 29.690
Authors: Michael A Portman; Nagib S Dahdah; April Slee; Aaron K Olson; Nadine F Choueiter; Brian D Soriano; Sujatha Buddhe; Carolyn A Altman Journal: Pediatrics Date: 2019-05-02 Impact factor: 7.124
Authors: Laura Gellis; Daniel A Castellanos; Rebecca Oduor; Kimberlee Gauvreau; Audrey Dionne; Jane Newburger; Kevin G Friedman Journal: J Cardiovasc Comput Tomogr Date: 2021-09-16
Authors: Paul Brogan; Jane C Burns; Jacqueline Cornish; Vinod Diwakar; Despina Eleftheriou; John B Gordon; Huon Hamilton Gray; Thomas William Johnson; Michael Levin; Iqbal Malik; Philip MacCarthy; Rachael McCormack; Owen Miller; Robert M R Tulloh Journal: Heart Date: 2019-12-16 Impact factor: 5.994
Authors: Shinsuke Hoshino; Sonia Jain; Chisato Shimizu; Samantha Roberts; Feng He; Lori B Daniels; Andrew M Kahn; Adriana H Tremoulet; John B Gordon; Jane C Burns Journal: Int J Cardiol Heart Vasc Date: 2021-09-01