Key result
Kawasaki disease history shows no difference in adverse cardiovascular events through age 21 versus controls.
Why the study?
Does a history of Kawasaki disease increase the long-term risk of adverse cardiovascular events in survivors?
Cohort (n=2,764)
Does a history of Kawasaki disease increase the long-term risk of adverse cardiovascular events in survivors?
Survivors of Kawasaki disease have a low rate of long-term adverse cardiovascular events through age 21 that is comparable to matched controls, although those with persistent coronary aneurysms remain at higher risk.
Answers are grounded in this paper and cite their sources.
Supports standard surveillance for Kawasaki survivors to age 21; leaves open need for longer-term studies in aneurysm subgroups.
BACKGROUND AND OBJECTIVE: Kawasaki disease (KD) may result in coronary aneurysm formation, but there is incomplete knowledge regarding its long-term effects. Our objective was to quantify the longer-term rates of adverse cardiac events in a modern North American KD cohort. METHODS: Using the Kaiser Permanente Northern California population, we performed a retrospective cohort study in patients with a history of KD versus matched patients without KD. Chart review was used to confirm the diagnosis of KD and all outcomes of interest, including acute coronary syndrome, coronary revascularization, heart failure, ventricular arrhythmia, valve disease, aortic aneurysm, and all-cause mortality. All outcomes occurring at age ≥15 years were included in the primary analysis. Outcome rates were compared between the 2 groups by using Cox proportional hazards analysis. RESULTS: The study included 546 KD patients and 2218 matched patients without KD. Seventy-nine percent of the KD patients received intravenous immunoglobulin and 5% had persistent coronary aneurysm. The average follow-up time was 14.9 years. Only 2 KD patients experienced outcomes after age 15 (0.246 events per 1000 person-years) compared with 7 events in the non-KD group (0.217 events per 1000 person-years), a nonsignificant difference (hazard ratio: 0.81; 95% confidence interval: 0.16-4.0). Within the KD subgroup, persistent coronary aneurysm predicted the occurrence of adverse events (P = .007). CONCLUSIONS: This is the largest US study of longer-term cardiac outcomes after KD and reveals a low rate of adverse cardiovascular events through age 21. Additional validation studies, including studies with longer-term follow-up, should be performed.
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Holve et al. (2014) conducted a cohort in Kawasaki disease (n=2,764). History of Kawasaki disease vs. Matched patients without Kawasaki disease was evaluated on Adverse cardiac events occurring at age ≥15 years (HR 0.81, 95% CI 0.16-4.0). A history of Kawasaki disease was associated with a low rate of adverse cardiovascular events through age 21, with no significant difference compared to matched controls (HR 0.81; 95% CI 0.16-4.0).
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