Abstract 16206: Adult Cardiovascular Outcomes in 546 Survivors of Childhood Kawasaki's Disease
Introduction: Kawasaki Disease (KD) is the most frequent cause of acquired heart disease in children, most commonly affecting the coronary arteries. Because the future cardiac risk after KD is unknown, we sought to quantify the effect of childhood KD on the long term rates of adverse cardiac events.
Methods: Using the Kaiser Permanente Northern California databases, we performed a retrospective cohort study of patients with an ICD-9 code for KD versus patients without KD, matched 1:4 by gender, age, region, and membership duration. Chart review was used to confirm the diagnosis of KD, collect detailed clinical data, and confirm all outcomes of interest, including: acute coronary syndrome (ACS), coronary revascularization, heart failure, ventricular arrhythmia, valve disease, aortic aneurysm, and all-cause mortality. All outcomes occurring at age >15 years were included in the analysis. The predictor variable was KD status. Outcome rates were compared between the two groups using Cox proportional hazards analysis, adjusting for relevant covariates. Secondary analyses within the KD group explored the predictive effects of aneurysm status and acute KD treatment.
Results: The study included 546 KD patients and 2218 matched patients without KD. The average time of follow-up was 14.9 +/-6.3 years. Persistent coronary aneurysm was noted in 25 KD patients (4.6%). Only 2 KD patients experienced outcomes (1 had ACS & CABG, and 1 had ACS; event rate 0.246 per 1000 person-years) versus 7 events in the non-KD group (event rate 0.217). These combined event rates were not significantly different (adjusted hazard ratio 0.81, 95% confidence intervals 0.16-4.0, P=0.8). Within the KD subgroup, persistent aneurysm status (P=0.007) but not KD treatment predicted the occurrence of adverse events.
Conclusion: This is the largest comprehensive study of long-term cardiac outcomes of KD in the U.S. The rate of long-term adverse cardiovascular events was extremely low in the KD population and was not different from a matched population without a history of KD. KD survivors with persistent coronary aneurysm may represent a higher risk subgroup that merits cardiovascular surveillance.
- © 2012 by American Heart Association, Inc.