Mid- to long-term outcomes and remodeling of coronary artery lesions in 569 children with kawasaki disease

Background Kawasaki disease (KD) is an acute systemic vasculitis and a leading cause of acquired heart disease in children. Coronary artery lesions (CALs) are the most severe complications，potentially leading to long-term cardiovascular morbidity. This study aimed to characterize the mid- to long-term progression and regression of CALs following the acute phase. Methods We conducted a retrospective cohort study of KD patients with CALs treated at our Hospital. CALs were stratified by severity using echocardiographic Z-scores. Clinical characteristics, laboratory parameters, treatment responses, and serial echocardiographic findings were collected. The primary outcomes included the regression, persistence, or progression of CALs, cardiac function, and major adverse cardiovascular events (MACE). Results A total of 569 KD patients with CALs discharged from our Hospital were included. During a median follow-up of 3.5 years,(range:[0.3-16.2years]), the baseline distribution of CALs was:isolated dilatation in 6.85%, small coronary artery aneurysms (SAAs) in 49.03%, medium-sized aneurysms (MAAs) in 34.62%, and giant coronary artery aneurysms (GAAs) in 9.49%.Most SAAs and MAAs showed significant regression over time. SAAs showed a regression rate of 100% within 1 year.In contrast,GAAs demonstrated the lowest regression rate and were significantly associated with persistent lesions and varying degrees of MACE.Timely administration of intravenous immunoglobulin (IVIG) was a key factor in favorable coronary remodeling. Conclusion While the majority of small-to-medium KD-related CALs exhibit favorable long-term outcomes and remodeling, GAAs pose a sustained risk for persistent lesions and MACE. Early risk stratification and lifelong cardiovascular surveillance are essential, particularly for patients with severe coronary involvement.