Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California; and.
Pediatrics. 2014 Feb;133(2):e305-11. doi: 10.1542/peds.2013-1638. Epub 2014 Jan 20.
Kawasaki disease (KD) may result in coronary aneurysm formation, but there is incomplete knowledge regarding its long-term effects. Our objective was to quantify the longer-term rates of adverse cardiac events in a modern North American KD cohort.
Using the Kaiser Permanente Northern California population, we performed a retrospective cohort study in patients with a history of KD versus matched patients without KD. Chart review was used to confirm the diagnosis of KD and all outcomes of interest, including acute coronary syndrome, 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 primary analysis. Outcome rates were compared between the 2 groups by using Cox proportional hazards analysis.
The study included 546 KD patients and 2218 matched patients without KD. Seventy-nine percent of the KD patients received intravenous immunoglobulin and 5% had persistent coronary aneurysm. The average follow-up time was 14.9 years. Only 2 KD patients experienced outcomes after age 15 (0.246 events per 1000 person-years) compared with 7 events in the non-KD group (0.217 events per 1000 person-years), a nonsignificant difference (hazard ratio: 0.81; 95% confidence interval: 0.16-4.0). Within the KD subgroup, persistent coronary aneurysm predicted the occurrence of adverse events (P = .007).
This is the largest US study of longer-term cardiac outcomes after KD and reveals a low rate of adverse cardiovascular events through age 21. Additional validation studies, including studies with longer-term follow-up, should be performed.
川崎病（KD）可能导致冠状动脉瘤形成，但对于其长期影响的认识尚不完整。我们的目的是定量评估现代北美 KD 患者队列的长期不良心脏事件发生率。
利用 Kaiser Permanente 北加州人群，我们对有 KD 病史的患者与无 KD 病史的匹配患者进行了回顾性队列研究。通过病历回顾来确认 KD 及所有感兴趣的结局的诊断，包括急性冠状动脉综合征、冠状动脉血运重建、心力衰竭、室性心律失常、瓣膜病、主动脉瘤和全因死亡率。所有≥15 岁时发生的结局均纳入主要分析。采用 Cox 比例风险分析比较两组之间的结局发生率。
本研究纳入了 546 例 KD 患者和 2218 例无 KD 病史的匹配患者。79%的 KD 患者接受了静脉注射免疫球蛋白治疗，5%的患者存在持续性冠状动脉瘤。平均随访时间为 14.9 年。仅有 2 例 KD 患者在 15 岁后发生结局（每 1000 人年 0.246 例），而无 KD 组有 7 例（每 1000 人年 0.217 例），差异无统计学意义（风险比：0.81；95%置信区间：0.16-4.0）。在 KD 亚组中，持续性冠状动脉瘤预测不良事件的发生（P =.007）。
这是美国最大的 KD 后长期心脏结局研究，结果显示 21 岁前不良心血管事件发生率较低。应开展进一步的验证研究，包括随访时间更长的研究。
