Treatment delay ups coronary artery aneurysm risk in Kawasaki disease patients

In patients with Kawasaki disease, every day that intravenous immunoglobulin (IVIG) treatment is delayed aggravates the risk of developing coronary artery aneurysms (CAA), a recent study has found.

Researchers conducted an observational cohort study of 776 Kawasaki disease patients (median age of onset, 2 years), of whom 707 (91.1 percent) were given IVIG treatment. Treatment was initiated an average of 8.3 days after disease onset. Twenty-three patients needed to be admitted to the paediatric intensive care unit.

During the observation period, three patients (0.4 percent) died due to myocardial infarction as a result of thrombotic CAAs.

Among the 96 patients who did not receive IVIF treatment, 21.7 percent developed CAAs, of which 11.6 percent were classified as giant and 1.4 percent as medium. In comparison, 22.9 percent of patients who did receive such treatment developed CAAs (5.1 percent medium, 7.3 percent giant).

Time to IVIG treatment was found to be an important factor for CAA development. The incidence rate of CAA was 19.7 percent in patients treated ≤10th day of disease, as opposed to 42.6 percent in those who were treated after. The resulting difference (p<0.001) and risk estimate (odds ratio [OR], 3.2, 95 percent confidence interval [CI], 2.2–4.9) were significant.

Per-day analysis further underscored the importance of timely treatment. Each additional day of IVIG delay increased the likelihood of developing both medium (OR, 1.1, 95 percent CI, 1.1–1.2; p<0.001) and giant (OR, 1.2, 95 percent CI, 1.1–1.2; p<0.001) CAA. No such effect was reported for small CAA (p=0.6).