Analysis of Coronary Arterial Aneurysm Regression in Patients With Kawasaki Disease by Aneurysm Severity: Factors Associated With Regression
Taichi Kato, Masaru Miura, Tohru Kobayashi, Tetsuji Kaneko, Naoya Fukushima, Kenji Suda, Jun Maeda, Shinya Shimoyama, Junko Shiono, Keiichi Hirono, Kazuyuki Ikeda, Seiichi Sato, Fujito Numano, Yoshihide Mitani, Kenji Waki, Mamoru Ayusawa, Ryuji Fukazawa, Shigeto Fuse, Masaru Miura, Ryuji Fukazawa, Shigeto Fuse, Kenji Hamaoka, Keiichi Hirono, Taichi Kato, Hitoshi Kato, Tohru Kobayashi, Tsutomu Saji, Kenji Suda, Kenji Waki, Hiroyuki Yamagishi, Naoya Fukushima, Masako Tomotsune, Makiko Yoshida, Tetsuji Kaneko, Manatomo Toyono, Kenji Furuno, Shinya Shimoyama, Satoru Iwashima, Yuji Moritou, Masahiro Kamada, Atsuhito Takeda, Junko Shiono, Tetsuya Sano, Daisuke Omori, Yoshie Fukasawa, Sayaka Mii, Yuichi Nomura, Tsuneyuki Nakamura, Jun Maeda, Masahiro Ishii, Syohei Ogata, Atushi Kitagawa, Masaki Yamamoto, Kazuyuki Ikeda, Kenichiro Yamamura, Yoshihide Mitani, Hiroshi Masuda, Masahide Kaneko, Yoichi Kawamura, Akiko Komori, Mamoru Ayusawa, Seiichi Sato, Fujito Numano, Hiroshi Suzuki, Kenichi Watanabe, Miyuki Hayashi, Makoto Watanabe, Kenji Kuraishi, Eiki Nishihara, Hiroshi Katayama, Kenichi Okumura, Tsutomu Takahashi, Norihisa Horita, Satoshi Matsuzaki, Noriko Motoki, Yohei Akazawa, Kentaro Aso, Kiyoshi Nagumo, Shinichi Takatuki, Eisuke Suganuma, Shinichi Matsuda, Yasunobu Hayabuchi, Shouzaburoh Doi, Takafumi Honda, Masaru Terai, Tomoyuki Miyamoto
Abstract
Background Coronary arterial aneurysms (CAAs) associated with Kawasaki disease (KD) significantly affect prognosis. However, the clinical course of CAAs and factors associated with CAA regression have not been well analyzed. Methods and Results The cohort of the Z‐Score 2nd Project Stage study, a multicenter, retrospective, cohort study involving 44 institutions in Japan including 1006 patients with KD, was examined. CAAs were classified by the z score of their internal diameter in the acute phase: small ( z <5), medium (5≤ z <10), and large ( z ≥10). The lower limit of small CAA was based on the Japanese Ministry of Health, Labour and Welfare criteria. In the right coronary artery, the CAA regression rates 10 years after diagnosis were 95.5% for small, 83.2% for medium, and 36.3% for large. In the proximal left anterior descending artery, the regression rates 10 years after diagnosis were 95.3% for small, 80.1% for medium, and 28.8% for large. Cox regression analysis showed that diagnosis under the age of 1 year and onset of KD in 2010 to 2012 for the right coronary artery and the left anterior descending artery, and female for the right coronary artery were significantly associated with a high regression rate, whereas large CAAs for the right coronary artery and the left anterior descending artery were significantly associated with a low regression rate. Conclusions The current study, the largest Japanese study of its kind, found that small aneurysm, recent onset, and diagnosis under the age of 1 year predict regression, and that even giant aneurysms could regress. These data may contribute to long‐term management of coronary aneurysms. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000010606.