Coronary artery calcifications in the long-term follow-up of Kawasaki disease.

BACKGROUND

To determine if detection of coronary artery calcifications in patients with Kawasaki disease may serve as a noninvasive predictor of future coronary artery events.

METHODS

A prospective, cohort pilot study that included 18 patients with Kawasaki disease > 1 year from the acute disease was performed including 9 patients with coronary abnormalities during the acute illness (Group 1) and 9 without coronary abnormalities (Group 2). Patients were classified by echocardiography as having none, resolved, or residual coronary artery abnormalities. Electron beam computed tomography (EBCT) scans were completed using the Agatson coronary calcium scoring system. Intermediate follow-up was performed 2.5 years after EBCT to determine if clinically significant coronary artery events (myocardial infarction or sudden death) had occurred.

RESULTS

Late echocardiographic abnormalities corresponded with the early echocardiographic abnormalities in 5 of 9 patients (P = .029) in Group 1. The late echocardiographic abnormalities significantly correlated with detection of calcifications by EBCT in 4 of 5 patients (95% CI 28%-99%). One patient with residual coronary abnormalities and coronary artery calcifications with the highest calcium score subsequently had a sudden death. Detection of coronary artery calcifications may be predictive of sudden death (P = .056). No residual echocardiographic abnormalities, coronary artery calcifications, or coronary artery events occurred in Group 2 patients.

CONCLUSIONS

Patients with Kawasaki disease with residual coronary abnormalities show EBCT evidence of coronary artery calcifications. Detection of coronary artery calcifications may be useful for risk stratification in the long-term management of patients with Kawasaki disease.