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A registry study of Kawasaki disease patients with coronary artery aneurysms (KIDCAR): a report on a multicenter prospective registry study three years after commencement

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Abstract

The long-term prognosis of patients with Kawasaki disease (KD) complicated by coronary artery aneurysms (CAA) is still unclear. The present, multicenter registry study aimed to study the factors associated with coronary events (CE) and determine an appropriate management method for patients with KD complicated with CAA. Patients with KD with onset after 2015 and with a medium-sized or large CAA having an actual diameter ≥ 4 mm or a Z-score ≥ 5.0 at 30 days and later after KD onset were included in the annual survey. The primary endpoint was the time-dependent incidence of CE. Associated factors were also examined. In total, 179 patients from 53 centers were enrolled and followed up for a median of 501 days. The median age at KD onset was 2.2 years, 137 patients were male (77%), 47 had incomplete KD (26%), and 36 had large CAA (20%). CE occurred in 13 patients (7%; 95% confidence interval: 4–12%); eight (62%) experienced CE within 1 year, and all the patients experienced a CE within 2 years. All but one patient received antiplatelet drugs and warfarin. Patients with a large CAA had significantly more CAA (2.8 vs. 1.7, p < 0.001), more cases of warfarin use (86% vs. 43%, p < 0.001), and were more likely to have CE (28% vs. 2%, p < 0.001) than those with a medium-sized CAA. On univariate Cox regression analysis, the factors significantly associated with CE were large CAA (hazard ratio (HR): 17.0), three or more CAA (HR: 23.3), and beaded CAA (HR: 15.9). Multivariable Cox regression analysis revealed that the only associated factor was a large CAA.

Conclusion: Patients with a large CAA were more likely to have a CE within 2 years. Antithrombotic therapy with warfarin did not eliminate the CE risk, and better therapies are desirable.

What is Known:

• Coronary artery aneurysms are a serious complication of Kawasaki disease, and coronary events are sometimes fatal.

• In previous, retrospective studies in Japan, large aneurysms, male sex, and refractoriness to initial immunoglobulin therapy were considered risk factors for coronary events.

What is New:

• Of 179 patients with a medium sized or large aneurysm, 13 (7%) experienced coronary events, all of which occurred within 2 years of onset. Factors significantly associated with coronary events were large aneurysms, three or more aneurysms, and beaded aneurysms.

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Abbreviations

ACEi:

Angiotensin-converting enzyme inhibitor

ARB:

Angiotensin receptor blocker

CAA:

Coronary artery aneurysm

CE:

Coronary event

CI:

Confidence interval

HR:

Hazard ratio

IQR:

Interquartile range

IVIG:

Intravenous immunoglobulin

IVMP:

Intravenous methylprednisolone

KD:

Kawasaki disease

MACE:

Major adverse cardiac event

SD:

Standard deviation

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Acknowledgements

We would like to express our deepest gratitude to Mr. James R. Valera, the in-house editor, for his help with editing this manuscript. We thank Tetsuji Kaneko, MSc, for his expert advice on statistical analysis. We would also like to thank Clinical Research Support Center at Tokyo Metropolitan Children’s Medical Center for their invaluable work in compiling the data.

We would also like to thank all our colleagues who took part in the KIDCAR study, including the following representatives of the collaborating institutions, which contributed patient data: Kentaro Aso, MD, PhD, St. Marianna University (2), Mamoru Ayusawa, MD, PhD, Nihon University (6), Ryota Ebata, MD, Chiba University Hospital (5), Ryuji Fukazawa, MD, PhD, Nippon Medical School Hospital (2), Kenji Furuno, MD, PhD, Fukuoka Children’s Hospital (10), Shigeto Fuse, MD, PhD, NTT EAST Medical Center Sapporo (4), Keiichi Hirono, MD, PhD, University of Toyama (1), Tatsunori Hokosaki, MD, PhD, Yokohama City University Hospital (27), Takafumi Honda, MD, Tokyo Women’s Medical University Yachiyo Medical Center (0), Hitoshi Horigome, MD, University of Tsukuba Hospital (4), Susumu Hosokawa, MD, Tokyo Medical and Dental University Hospital (6), Kazuyuki Ikeda, MD, PhD, Kyoto Prefectural University of Medicine (4), Sachiko Inukai, MD, PhD, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital (1), Satoru Iwashima, MD, PhD, Chutoen General Medical Center (4), Taichi Kato, MD, PhD, Nagoya University Graduate School of Medicine (0), Yasuhiro Katsube, MD, Nippon Medical School Musashikosugi Hospital (3), Kanta Kishi, MD, Osaka Medical and Pharmaceutical University Hospital (0), Tohru Kobayashi, MD, PhD, National Center for Child Health and Development (12), Kazuki Kodo, MD, PhD, Keio University Hospital (1), Kenji Kuraishi, MD, Ogaki Municipal Hospital (1), Tomoyo Matsubara, MD, Dokkyo Medical University Saitama Medical Center (0), Masahiro Misawa, MD, Tokyo Metropolitan Bokutoh Hospital (4), Yoshihide Mitani, MD, PhD, Mie University Graduate School of Medicine (0), Masaru Miura, MD, PhD, Tokyo Metropolitan Children’s Medical Center (15), Noriko Nagai, MD, Okazaki City Hospital (3), Naomi Nakagawa, MD, Hiroshima City Hiroshima Citizens’ Hospital (0), Koichi Nihei, MD, PhD, Toho University Ohashi Medical Center (0), Yuichi Nomura, MD, PhD, Kagoshima City Hospital (0), Fujito Numano, MD, Niigata University Medical & Dental Hospital (15), Yoshiyuki Sakai, MD, Hakodate Municipal Hospital (0), Mitsuru Seki, MD, PhD, Jichi Children’s Medical Center Tochigi (3), Shinya Shimoyama, MD, PhD, Gunma Children’s Medical Center (3), Junko Shiono, MD, PhD, Ibaraki Children’s Hospital (6), Kenji Suda, MD, PhD, Kurume University Hospital (3), Eisuke Suganuma, MD, PhD, Saitama Children’s Medical Center (17), Hiroyuki Suzuki, MD, Wakayama Medical University Hospital (0), Tsutomu Takahashi, MD, PhD, Saiseikai Utsunomiya Hospital (1), Shinichi Takatsuki, MD, Toho University Medical Center Omori Hospital (2), Atsuhito Takeda, MD, PhD, Hokkaido University Hospital (2), Manatomo Toyono, MD, PhD, Akita University Hospital (0), Keiji Tsuchiya, MD, Japanese Red Cross Medical Center (2), Etsuko Tsuda, MD, National Cerebral and Cardiovascular Center (1), Kentaro Ueno, MD, PhD, Kagoshima University Hospital (1), Masafumi Utsumi, MD, Shinshu University Hospital (2), Kenji Waki, MD, PhD, Kurashiki Central Hospital (5), and Kenichiro Yamamura, MD, PhD, Kyushu University (1).

Funding

This study was supported by grants from the Japan Agency for Medical Research and Development (AMED) (Grant number: JP20ek0109467), Tokyo Metropolitan Government Hospitals, and the Japanese Society of Kawasaki Disease.

Author information

Authors and Affiliations

  1. Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan

    Yutaro Koyama & Masaru Miura

  2. Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan

    Tohru Kobayashi

  3. Department of Pediatric Cardiology, Yokohama City University Hospital, Kanagawa, Japan

    Tatsunori Hokosaki

  4. Division of Infectious Diseases, Immunology and Allergy, Saitama Children’s Medical Center, Saitama, Japan

    Eisuke Suganuma

  5. Department of Pediatrics, Niigata University Medical & Dental Hospital, Niigata, Japan

    Fujito Numano

  6. Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children’s Hospital, Fukuoka, Japan

    Kenji Furuno

  7. Department of Pediatric Cardiology, Ibaraki Children’s Hospital, Ibaraki, Japan

    Junko Shiono

  8. Department of Pediatrics, Chiba University Hospital, Chiba, Japan

    Ryota Ebata

  9. Department of Clinical Laboratory, NTT EAST Medical Center Sapporo, Hokkaido, Japan

    Shigeto Fuse

  10. Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan

    Ryuji Fukazawa

  11. Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan

    Yoshihide Mitani

Authors
  1. Yutaro Koyama
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  2. Masaru Miura
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  4. Tatsunori Hokosaki
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  5. Eisuke Suganuma
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  6. Fujito Numano
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  7. Kenji Furuno
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  8. Junko Shiono
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  9. Ryota Ebata
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  10. Shigeto Fuse
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  11. Ryuji Fukazawa
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  12. Yoshihide Mitani
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Contributions

Masaru Miura and Tohru Kobayashi contributed to the study conception, design, and methodology. Formal analysis was performed by Yutaro Koyama and Tohru Kobayashi. All the authors contributed to resource and data curation. The first draft of the manuscript was written by Yutaro Koyama, Masaru Miura, and Tohru Kobayashi. All the authors have commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Masaru Miura.

Ethics declarations

Ethics approval

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and the ethical guidelines of the Ministry of Health, Labour and Welfare and was approved by the central ethics committee of Tokyo Metropolitan Children’s Medical Center (approval number: H28b-60). The study was registered with the University Hospital Medical Information Network Clinical Trials Registry under UMIN000024768.

Consent to participate

Verbal informed consent was obtained from the parents as also noted in the medical records.

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Not applicable.

Conflicts of interest

The authors dedclare no competing interests.

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Communicated by Peter de Winter

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Koyama, Y., Miura, M., Kobayashi, T. et al. A registry study of Kawasaki disease patients with coronary artery aneurysms (KIDCAR): a report on a multicenter prospective registry study three years after commencement. Eur J Pediatr 182, 633–640 (2023). https://doi.org/10.1007/s00431-022-04719-x

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