Long-Term Management of Kawasaki Disease: Key Updates in the 2024 American Heart Association (AHA) Scientific Statement

This review primarily focuses on the long-term management guidelines for Kawasaki disease, specifically analyzing the 2024 American Heart Association (AHA) Scientific Statement and its updates from the 2017 version. A fundamental shift in the 2024 statement is the emphasis on peak z-score rather than the current coronary artery status for risk stratification. The updated guidelines also advocate for multimodal imaging, transitioning from an echocardiography-centered approach to the use of Coronary CT Angiography and Cardiac MRI to monitor calcification and silent myocardial ischemia. Regarding pharmacotherapy, the 2024 statement suggests considering statin therapy, particularly for those in Level 4 or higher, to stabilize the endothelium and reduce chronic inflammation. Furthermore, direct oral anticoagulants are now introduced as alternative antithrombotic options for select adult patients or those with challenges in warfarin management. For high-risk patients with giant coronary artery aneurysms (Level 4–5), the statement provides a detailed long-term surveillance algorithm involving dual antithrombotic therapy and functional stress testing. To ensure continuity of care, a structured transition protocol is emphasized to facilitate the seamless transfer of patients from pediatric to adult cardiology. Ultimately, the 2024 AHA Scientific Statement redefines Kawasaki disease as a chronic cardiovascular condition requiring a precision-based, lifelong management strategy.