Coronary artery dilation, younger age linked to coronary artery aneurysm in Kawasaki disease

In children with Kawasaki disease, coronary artery dilation at diagnosis and age below 6 months predict coronary artery aneurysm across Japanese and US cohorts.

Researchers conducted a retrospective cohort study including 42,350 children from the 26th and 27th Japanese Nationwide Kawasaki Disease Surveys (2019–2022) and 1,216 children from a multiethnic US cohort. All children received initial intravenous immunoglobulin (IVIG) at 2 g/kg within 10 illness days and had echocardiographic data available at around 1 month after onset of disease.

Multivariable logistic regression was applied to analyse associations between clinical variables and coronary artery aneurysm at 1 month after disease onset.

At baseline, the median age was 24 months in the Japan cohort and 32 months in the San Diego cohort. The median illness day at diagnosis was 5 and 6, respectively. A total of 3.5 percent of children in the Japan cohort and 19 percent in the San Diego cohort had coronary artery dilation at diagnosis. IVIG resistance occurred in 21.8 percent and 16 percent, respectively.

In both cohorts, baseline coronary artery dilation at diagnosis was strongly associated with coronary artery aneurysm at 1 month after disease onset (Japan: odds ratio [OR], 22.7; San Diego: OR, 13.4). Other risk factors were age younger than 6 months and IVIG resistance. These associations were observed for medium to giant coronary artery aneurysms.

In stratified analyses, IVIG resistance had a pronounced association with subsequent coronary artery aneurysm among children with normal coronary arteries at diagnosis.

The findings provide important prognostic information and may inform cardiovascular risk stratification and management in children with Kawasaki disease.