High-dose intravenous immunoglobulin administered within 10 days of fever onset reduces the risk of coronary artery aneurysms 5-fold (from 20%) in children with Kawasaki disease.
Kawasaki disease is a significant cause of coronary artery aneurysms and subsequent acute coronary syndrome in young adults, highlighting the critical importance of early IVIG treatment.
Effect estimate: 5-fold reduction
Absolute Event Rate: 4% vs 20%
Kawasaki disease is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and children. If not treated early with high-dose intravenous immunoglobulin, 1 in 5 children develop coronary artery aneurysms; this risk is reduced 5-fold if intravenous immunoglobulin is administered within 10 days of fever onset. Coronary artery aneurysms evolve dynamically over time, usually reaching a peak dimension by 6 weeks after illness onset. Almost all the morbidity and mortality occur in patients with giant aneurysms. Risk of myocardial infarction from coronary artery thrombosis is greatest in the first 2 years after illness onset. However, stenosis and occlusion progress over years. Indeed, Kawasaki disease is no longer a rare cause of acute coronary syndrome presenting in young adults. Both coronary artery bypass surgery and percutaneous intervention have been used to treat Kawasaki disease patients who develop myocardial ischemia as a consequence of coronary artery aneurysms and stenosis.
Newburger et al. (Fri,) conducted a review in Kawasaki disease. Intravenous immunoglobulin vs. No early treatment was evaluated on Coronary artery aneurysms (5-fold reduction). High-dose intravenous immunoglobulin administered within 10 days of fever onset reduces the risk of coronary artery aneurysms 5-fold (from 20%) in children with Kawasaki disease.