Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, PR China.
Cardiol Young. 2020 Jun;30(6):834-839. doi: 10.1017/S1047951120001134. Epub 2020 Jun 8.
Giant coronary aneurysms are the most severe complications of Kawasaki disease. There are few reports of outcomes from China. Most previous studies were based only on absolute aneurysmal dimensions. The aim of the present study was to catalog the outcomes of Kawasaki disease with giant coronary aneurysms in southwest China based on absolute dimensions and the z-score adjusted for body surface area.
All patients diagnosed with giant coronary aneurysms (z-score ≥ 10 or absolute dimension ≥ 8 mm) between December, 2002 and December, 2018 were included. We retrospectively analysed patient characteristics and clinical data from 38 patients with giant coronary aneurysms. Over a median follow-up period of 30.5 months (range from 1.7 months to 22.3 years), including patients in chronic phase who had been diagnosed prior to 2002, eight patients had myocardial infarction, including two deaths and one patient with coronary artery bypass grafting. The 1-, 2-, and 5-year event-free rates were 0.63, 0.63, and 0.53 for thrombosis, respectively, and 0.86, 0.81, and 0.81 for major adverse cardiac events, respectively. The 1-, 2-, and 5-year regression-free rates were 0.94, 0.85, and 0.67, respectively. A total of 73.7% of patients remained active.
In the early stages of Kawasaki disease, patients with giant coronary aneurysms often experience major cardiovascular events; however, they are also likely to have normalisation of the coronary internal luminal diameter. With long-term anticoagulation, close cardiologic monitoring, and prompt thrombolytic therapy, most patients can achieve disease-free periods.
巨大冠状动脉瘤是川崎病最严重的并发症。中国的相关报道较少。既往的大多数研究仅基于绝对动脉瘤尺寸。本研究旨在根据绝对尺寸和体表面积校正的 z 评分，对中国西南地区川崎病伴巨大冠状动脉瘤的结局进行分类。
纳入 2002 年 12 月至 2018 年 12 月诊断为巨大冠状动脉瘤（z 评分≥10 或绝对尺寸≥8mm）的所有患者。我们回顾性分析了 38 例巨大冠状动脉瘤患者的患者特征和临床资料。在中位数为 30.5 个月（1.7 个月至 22.3 年）的随访期内，包括 2002 年前诊断为慢性期的患者，有 8 例发生心肌梗死，包括 2 例死亡和 1 例接受冠状动脉旁路移植术。血栓形成的 1、2 和 5 年无事件生存率分别为 0.63、0.63 和 0.53，主要不良心脏事件分别为 0.86、0.81 和 0.81。无再狭窄的 1、2 和 5 年生存率分别为 0.94、0.85 和 0.67。73.7%的患者仍处于活动期。
在川崎病的早期阶段，巨大冠状动脉瘤患者常发生重大心血管事件；然而，他们的冠状动脉管腔内径也可能恢复正常。长期抗凝、密切心脏监测和及时溶栓治疗，大多数患者可以实现无病期。
