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(Circulation. 2005;111:38-43.)
© 2005 American Heart Association, Inc.

Coronary Heart Disease

Elevated Levels of High-Sensitivity C-Reactive Protein and Serum Amyloid-A Late After Kawasaki Disease

Association Between Inflammation and Late Coronary Sequelae in Kawasaki Disease

Yoshihide Mitani, MD, PhD; Hirofumi Sawada, MD; Hidetoshi Hayakawa, MD, PhD; Kenzo Aoki, MD, PhD; Hiroyuki Ohashi, MD; Masahiko Matsumura, MD, PhD; Kenji Kuroe, MD; Hideto Shimpo, MD, PhD; Masataka Nakano, PhD; Yoshihiro Komada, MD, PhD

From the Department of Pediatrics, Mie University School of Medicine, Tsu, Mie (Y.M., H.S., Y.K.); the Department of Pediatrics, Yamada Red Cross Hospital, Watarai, Mie (H.H.); the Department of Pediatrics, Matsusaka City Hospital, Matsusaka, Mie (K.A., H.O.); the Department of Pediatrics, Tenri Hospital, Tenri, Nara (M.M.); the Department of Cardiology, Hyogo Children’s Hospital, Kobe, Hyogo (K.K.); the Department of Thoracic Cardiovascular Surgery, Mie University School of Medicine, Tsu, Mie (H.S.); and the Department of Community Nursing, Mie University School of Nursing, Tsu, Mie (M.N.), Japan.

Correspondence to Yoshihide Mitani, MD, PhD, Department of Pediatrics, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan. E-mail ymitani{at}clin.medic.mie-u.ac.jp

Received April 6, 2004; revision received September 28, 2004; accepted September 30, 2004.

Background— Coronary sequelae that persist after Kawasaki disease (KD) have been associated with obstructive changes of the lesions and coronary vascular events in adolescents and young adults. However, little is known about the association between sequelae late after KD and inflammatory markers, which are potential mediators and markers for atherogenesis.

Methods and Results— Cross-sectional study was performed to test the hypothesis that coronary sequelae are associated with elevated levels of inflammatory markers in patients late after KD (mean time interval after the onset, 10 years, 10 months). Levels of high-sensitivity C-reactive protein (CRP), serum amyloid-A (SAA), interleukin-6, and soluble intercellular adhesion molecule-1 were measured in the 4 groups (n=80): the referent group (n=15) and KD subgroups with normal coronary arteries from the onset (n=27); with regressed aneurysms (n=18); and with coronary artery lesions, such as persistent aneurysms, stenosis, and occlusion (n=20). CRP levels were significantly elevated in a KD subgroup with coronary artery lesions compared with the referent or other KD subgroups, as analyzed by ANOVA and ANCOVA after adjustment for a confounding factor body mass index. Levels of CRP, SAA, and interleukin-6 were positively correlated. Stepwise regression and logistic regression analyses support the association between the persistence of coronary artery lesions and the levels of CRP and SAA.

Conclusions— Results demonstrate that the persistence of coronary lesions late after KD was independently associated with levels of CRP and SAA, suggesting that inflammation may be a novel functional aspect of coronary artery diseases late after KD.

Key Words: atherosclerosis • coronary disease • risk factors • pediatrics • prevention

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