Acute-phase Treatment and Prevention of Large Coronary Artery Lesions in Kawasaki Disease

Background: The use of corticosteroids as treatment for Kawasaki disease (KD) patients is still controversial. And the effects of corticosteroids on coronary artery lesions (CALs) development and later vascular remodeling are also unclear. The purpose of this study was to compare the long term prognosis of KD with CALs between corticosteroid administration patients and no corticosteroid using patients. Methods: Five hundred sixty nine patients with KD were studied at Kurume University Hospital from 1996 to 2004. Clinical records of 66 patients (46 males, 20 females) with CALs were reviewed. The median age at diagnosis was 1.5 (range 0.2 - 13.2) years and median follow-up period was 8.9 (range 0.1 - 16.4) years. Coronary artery sizes were measured by body surface area (BSA) adjusted z-score to using echocardiography. CALs were defined as coronary artery z-score > 2.5, and CAL regressions were defined as z-score < 2.5. Results: Sixty four patients were treated with intravenous immunoglobulin (IVIG), and 51 (79.7%) patients were unresponsive to the initial IVIG treatment. Twenty seven (40.9%) patients were received corticosteroid pulse therapy in the acute phase. The maximum CAL z-score in the acute phase, there were not significant differences between corticosteroid administration patients and no corticosteroid using patients (5.1 ± 2.2 vs. 4.9 ± 2.3, p = 0.277). The CAL z-score at the end of this study period, there were not significant differences between two groups (2.1 ± 2.0 vs. 2.3 ± 2.3, p = 0.432). The ratio of CAL regression in the study period (33.3% vs. 46.2%), the mean interval between the onset of KD and CAA regression (0.6 ± 0.5 vs. 0.8 ± 0.5 years, p = 0.209), and the ratio of coronary artery stenosis or occlusion (14.8% vs. 15.4%), there were not significant differences between two groups. Conclusion: Corticosteroid pulse therapy for KD patients may not be worsened CALs in the acute phase and long-term after the onset.

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Acute Phase Treatment for Prevention of Coronary Artery Stenosis Caused in Kawasaki Disease: A Single Center Retrospective Study

Journal of Advanced Research in Medicine ◽

10.24321/2349.7181.201818 ◽

2018 ◽

Vol 05 (04) ◽

pp. 1-7

Author(s):

Toshimasa Nakada ◽

Keyword(s):

Retrospective Study ◽

Coronary Artery ◽

Kawasaki Disease ◽

Acute Phase ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Single Center ◽

Acute Phase Treatment

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Acute Phase Treatment and Medium-Term Outcomes in Kawasaki Disease

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.4.419 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Toshimasa Nakada

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Acute Phase ◽

Coronary Artery Stenosis ◽

Ivig Therapy ◽

Initial Therapy ◽

Artery Stenosis ◽

Cardiac Events ◽

Medium Term ◽

Acute Phase Treatment

An acute phase treatment for prevention of coronary artery stenosis caused by Kawasaki disease (KD) has not been established. The objective of this study was to clarify the medium-term outcomes of patients who received acute phase treatment in our department. This retrospective study included data from 214 patients with KD who received acute phase treatment from January 2009 to May 2020. A total of 196 (92.1%) received an initial single dose of intravenous immunoglobulin (IVIG) therapy. One patient with status epilepticus at presentation received initial IVIG plus steroid therapy. A total of 17 patients did not receive IVIG. The rate of coronary artery lesions (CALs) 1 month and 1 year after KD onset were 1.9% and 0.9%, respectively. Two patients had CAL 1 year after KD onset. However, no patients had coronary artery stenosis. One patient with a right giant CAL had a medium CAL before initial therapy. During a median follow-up period of 3 years and 4 months, no patients had cardiac events that required therapy.

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