Association of severity of coronary artery aneurysms in patients with kawasaki disease and risk of later coronary events

Z-score Project 2nd Stage Study Group

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

IMPORTANCE Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). OBJECTIVE To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. DESIGN, SETTING, AND PARTICIPANTS This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. MAIN OUTCOMES AND MEASURES The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score,-5 to <10; actual internal diameter, <8 mm), and large (z score,-10 or-8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. RESULTS Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52%in men (P < .001) and 100%, 100%, and 75%in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100%, 96%, and 79% in patients who were not resistant to IVIG therapy (P < .001) and 100%, 96%, and 51%in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95%CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95%CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95%CI, 1.4-3.6) were significantly associated with CE. CONCLUSIONS AND RELEVANCE Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.

Original languageEnglish
Article numbere180030
JournalJAMA Pediatrics
Volume172
Issue number5
DOIs
Publication statusPublished - 2018 May 1

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Coronary Aneurysm
Mucocutaneous Lymph Node Syndrome
Coronary Vessels
Intravenous Immunoglobulins
Passive Immunization
Sex Ratio
Coronary Angiography
Proportional Hazards Models
Disease-Free Survival
Pathologic Constriction
Thrombosis
Cohort Studies
Survival Rate
Retrospective Studies
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Association of severity of coronary artery aneurysms in patients with kawasaki disease and risk of later coronary events. / Z-score Project 2nd Stage Study Group.

In: JAMA Pediatrics, Vol. 172, No. 5, e180030, 01.05.2018.

Research output: Contribution to journalArticle

@article{9ab6d0aa63e84d12840102968c27f837,
title = "Association of severity of coronary artery aneurysms in patients with kawasaki disease and risk of later coronary events",
abstract = "IMPORTANCE Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). OBJECTIVE To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. DESIGN, SETTING, AND PARTICIPANTS This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. MAIN OUTCOMES AND MEASURES The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score,-5 to <10; actual internal diameter, <8 mm), and large (z score,-10 or-8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. RESULTS Of 1006 patients, 714 (71{\%}) were male, 341 (34{\%}) received a diagnosis before age 1 year, 501 (50{\%}) received a diagnosis between age 1 and 5 years, and 157 (16{\%}) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100{\%}, 94{\%}, and 52{\%}in men (P < .001) and 100{\%}, 100{\%}, and 75{\%}in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100{\%}, 96{\%}, and 79{\%} in patients who were not resistant to IVIG therapy (P < .001) and 100{\%}, 96{\%}, and 51{\%}in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95{\%}CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95{\%}CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95{\%}CI, 1.4-3.6) were significantly associated with CE. CONCLUSIONS AND RELEVANCE Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.",
author = "{Z-score Project 2nd Stage Study Group} and Masaru Miura and Tohru Kobayashi and Tetsuji Kaneko and Mamoru Ayusawa and Ryuji Fukazawa and Naoya Fukushima and Shigeto Fuse and Kenji Hamaoka and Keiichi Hirono and Taichi Kato and Yoshihide Mitani and Seiichi Sato and Shinya Shimoyama and Junko Shiono and Kenji Suda and Hiroshi Suzuki and Jun Maeda and Kenji Waki and Hitoshi Kato and Tsutomu Saji and Hiroyuki Yamagishi and Aya Ozeki and Masako Tomotsune and Makiko Yoshida and Yohei Akazawa and Kentaro Aso and Shouzaburoh Doi and Yoshi Fukasawa and Kenji Furuno and Yasunobu Hayabuchi and Miyuki Hayashi and Takafumi Honda and Norihisa Horita and Kazuyuki Ikeda and Masahiro Ishii and Satoru Iwashima and Masahiro Kamada and Masahide Kaneko and Hiroshi Katyama and Yoichi Kawamura and Atushi Kitagawa and Akiko Komori and Kenji Kuraishi and Hiroshi Masuda and Shinichi Matsuda and Satoshi Matsuzaki and Sayaka Mii and Tomoyuki Miyamoto and Yuji Moritou and Noriko Motoki",
year = "2018",
month = "5",
day = "1",
doi = "10.1001/jamapediatrics.2018.0030",
language = "English",
volume = "172",
journal = "JAMA Pediatrics",
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T1 - Association of severity of coronary artery aneurysms in patients with kawasaki disease and risk of later coronary events

AU - Z-score Project 2nd Stage Study Group

AU - Miura, Masaru

AU - Kobayashi, Tohru

AU - Kaneko, Tetsuji

AU - Ayusawa, Mamoru

AU - Fukazawa, Ryuji

AU - Fukushima, Naoya

AU - Fuse, Shigeto

AU - Hamaoka, Kenji

AU - Hirono, Keiichi

AU - Kato, Taichi

AU - Mitani, Yoshihide

AU - Sato, Seiichi

AU - Shimoyama, Shinya

AU - Shiono, Junko

AU - Suda, Kenji

AU - Suzuki, Hiroshi

AU - Maeda, Jun

AU - Waki, Kenji

AU - Kato, Hitoshi

AU - Saji, Tsutomu

AU - Yamagishi, Hiroyuki

AU - Ozeki, Aya

AU - Tomotsune, Masako

AU - Yoshida, Makiko

AU - Akazawa, Yohei

AU - Aso, Kentaro

AU - Doi, Shouzaburoh

AU - Fukasawa, Yoshi

AU - Furuno, Kenji

AU - Hayabuchi, Yasunobu

AU - Hayashi, Miyuki

AU - Honda, Takafumi

AU - Horita, Norihisa

AU - Ikeda, Kazuyuki

AU - Ishii, Masahiro

AU - Iwashima, Satoru

AU - Kamada, Masahiro

AU - Kaneko, Masahide

AU - Katyama, Hiroshi

AU - Kawamura, Yoichi

AU - Kitagawa, Atushi

AU - Komori, Akiko

AU - Kuraishi, Kenji

AU - Masuda, Hiroshi

AU - Matsuda, Shinichi

AU - Matsuzaki, Satoshi

AU - Mii, Sayaka

AU - Miyamoto, Tomoyuki

AU - Moritou, Yuji

AU - Motoki, Noriko

PY - 2018/5/1

Y1 - 2018/5/1

N2 - IMPORTANCE Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). OBJECTIVE To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. DESIGN, SETTING, AND PARTICIPANTS This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. MAIN OUTCOMES AND MEASURES The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score,-5 to <10; actual internal diameter, <8 mm), and large (z score,-10 or-8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. RESULTS Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52%in men (P < .001) and 100%, 100%, and 75%in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100%, 96%, and 79% in patients who were not resistant to IVIG therapy (P < .001) and 100%, 96%, and 51%in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95%CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95%CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95%CI, 1.4-3.6) were significantly associated with CE. CONCLUSIONS AND RELEVANCE Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.

AB - IMPORTANCE Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). OBJECTIVE To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. DESIGN, SETTING, AND PARTICIPANTS This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. MAIN OUTCOMES AND MEASURES The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score,-5 to <10; actual internal diameter, <8 mm), and large (z score,-10 or-8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. RESULTS Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52%in men (P < .001) and 100%, 100%, and 75%in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100%, 96%, and 79% in patients who were not resistant to IVIG therapy (P < .001) and 100%, 96%, and 51%in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95%CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95%CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95%CI, 1.4-3.6) were significantly associated with CE. CONCLUSIONS AND RELEVANCE Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.

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