Abstract:
Background: Kawasaki Disease (KD) is a systemic vasculitis of childhood and the leading cause of acquired heart disease. Coronary artery aneurysm (CAA) remains the most serious complication. Data on the long-term outcomes of CAAs remains limited.
Objective: We aim to analyze the long-term outcomes of CAAs in KD. We evaluate the rates of regression and complications and assess the impact of medical and surgical interventions.
Methods: Databases were searched and duplicates removed. Shortlisted studies were screened. Relevant data was extracted and analyzed. Key outcomes included incidence and regression of CAA, Major Adverse Cardiac Events (MACE), Cardiac death and adjunctive therapies.
Results: 23 studies and 12183 patients were included. Incidence of CAAs in KD ranged between 3 - 27%. Infants less than 6 months were affected more. Small and moderate aneurysms were more likely to regress (>80%) as compared to Giant aneurysms (<35%). Thrombosis was reported in 45% cases, myocardial infarction in 1.5 - 16%, MACE in 5 - 14% and cardiac death in 18%. Early initiation of IVIG increases chances of regression (91%). Aneurysms in the LAD were less likely to regress suggesting a possible anatomical association. CABG was the most common surgical intervention.
Conclusion: Early and aggressive management with IVIG and escalation to steroids and biologics remains the preferred approach. Inflammatory markers can help in risk stratification. Surgical interventions may be required for Giant or persistent aneurysms. The findings suggest the need for standardized guidelines.
Keywords: Kawasaki disease, Pediatric vasculitis, Coronary artery aneurysm, IVIG, MACE, CABG, PCI.
