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Epidemiology and Risk Factors for Giant Coronary Artery Aneurysms Identified After Acute Kawasaki Disease

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Abstract

A giant coronary artery (CA) aneurysm is a potentially fatal cardiac complication resulting from Kawasaki disease (KD). We aimed to identify epidemiologic characteristics and potential risk factors associated with giant CA aneurysms identified after acute KD. We analyzed 90,252 patients diagnosed with KD from 2011 to 2018, using data obtained in nationwide KD surveys conducted in Japan. Multivariable logistic regression analyses were performed to evaluate potential risk factors associated with subsequent giant CA aneurysm complications (defined as lumen size ≥ 8 mm), adjusting for all potential factors. Giant CA aneurysms were identified in 144 patients (0.16%) after acute KD. The annual prevalence ranged from 0.07 to 0.20% during the study period. In the multivariate analyses, male sex (adjusted odds ratio 2.09 [95% confidence interval 1.41–3.11], recurrent KD (1.90 [1.09–3.33]), IVIG administration at 1–4 days of illness (1.49 [1.04–2.15]) and ≥ 8 days after KD onset (2.52 [1.38–4.60]; reference, 5–7 days), detection of CA dilatations and aneurysms at initial echocardiography (4.17 [1.85–5.41] and 46.5 [28.8–74.8], respectively), and resistance to IVIG treatment (6.09 [4.23–8.75]) were significantly associated with giant CA aneurysm complications identified after acute KD. The annual prevalence of giant CA aneurysms identified after acute KD did not increase during the study period. Patients with larger CA abnormalities detected at initial echocardiography were independently associated with progression to giant CA aneurysm complications after acute KD regardless of the number of days from onset at treatment initiation.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all the pediatricians who contributed to the nationwide surveys of Kawasaki disease in Japan. We also thank Alison Sherwin, PhD, from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript. The study was partially supported by grants and funding from a non-profit organization, The Japan Kawasaki Disease Research Center.

Funding

The study was partially supported by Grants and funding from a non-profit organization, the Japan Kawasaki Disease Research Center.

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Author notes

  1. Ryusuke Ae Contributed equally as co-first author.

Authors and Affiliations

  1. Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan

    Hiroya Masuda, Ryusuke Ae, Koki Kosami, Kanako Hayashida, Nobuko Makino, Yuri Matsubara, Teppei Sasahara & Yosikazu Nakamura

  2. Division of Molecular Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Taka-aki Koshimizu

  3. Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Masami Matsumura

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  1. Hiroya Masuda
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Contributions

HM: Conceptualization, Formal analysis, Investigation, Software, Writing—original draft. RA: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Software, Writing—original draft. TK: Conceptualization, Supervision, Writing—review and editing. MM: Supervision, Final approve. KK: Formal analysis, Investigation, Methodology, Software. KH: Formal analysis, Investigation. NM: Data curation, Supervision. YM: Data curation, Formal analysis. TS: Data curation, Supervision. YN: Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing—review and editing.

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Correspondence to Ryusuke Ae.

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Conflict of interest

Dr. Nakamura reported receiving grants and funding from a non-profit organization, the Japan Kawasaki Disease Research Center. No other disclosures were reported.

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Jichi Medical University Clinical Research Ethics Committee approved the study and waived the requirement for informed consent of each participant (Receipt ID: 18-070).

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All authors have contributed significantly to the work, approved the manuscript, and agree with the submission and publication.

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Masuda, H., Ae, R., Koshimizu, Ta. et al. Epidemiology and Risk Factors for Giant Coronary Artery Aneurysms Identified After Acute Kawasaki Disease. Pediatr Cardiol 42, 969–977 (2021). https://doi.org/10.1007/s00246-021-02571-8

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