626 Mid to Long-Term Follow-Up of 56 Children with Kawasaki Disease Complicated with Medium or Giant Coronary Aneurysms

Abstract

Objective: This study sought to evaluate the mid to long-term prognosis of medium or giant coronary aneurysms in children with Kawasaki disease. Method: The clinical data of children with medium or giant coronary aneurysms due to Kawasaki disease were analyzed, which include size and location of the coronary aneurysms, the duration from the onset of the illness, clinical presentations, and 2D-echo, ECG, 64 slice-spiral CT coronary angiogram results. Survival analysis was perfromed by using Kaplan-meier. Results: Fifty-six children with medium and giant coronary aneurysms were included. According to the AHA risk stratification of patients with Kawasaki disease, 16 of them were classified into risk level III, 40 children were classified into risk level IV. The median follow-up time was 3.5 years. The cardiac event rate was 4(beta)5 (11.4%) in children with gaint aneurysms, while no cardiac event occurred in children with medium aneurysms. Two children with giant aneurysms died of myocardial infarction 10 month and 4 years after the acute phase of Kawasaki disease. Other two with giant aneurysms suffered from angina pectoris 2 month and 14 years respectively after the acute phase of KD. ECG detected abnormal Q waves in 7 patients, ST-T changes in 3 patients, and first A-V block in 1 girl. Forty-one patients had no evidence of myocardial ischemia by the end of this follow-up. Around 87.3% of the medium-sized and 93.8% of the giant aneurysms located in LM, LAD, proximal RCA. Medium and giant coronary aneurysms occurred rarely in LCX and distal RCA. In the convalescent phase, 58.4% of the aneurysms had the tendency to regress, and 34.9% of the affected coronary artery branches totally recovered. Multiple logistic regression shows that the age of the onset, follow-up period and the initial size of the aneurysm are influencing factors of the regression of the aneurysms (P<0.05). Conclusion: The coronary aneurysms due to kawasaki disease have the tendency to regress during the convalescent phase, cardiac events occurred only in patients with gaint aneurysms, and the overall cardiac events rate in these group of patients is probably lower as compared to those reported from abroad.