123 - LONG-TERM OUTCOMES OF GIANT CORONARY ANEURYSMS IN CHILDREN WITH KAWASAKI DISEASE

Background: Giant coronary aneurysms (GCA) are rare but concerning complications following KD. The long-term outcomes of this condition have not been described in France. The aim of this study is to evaluate our experience with GCA in KD and identify risk factors for persistent GCA and cardiac events.

Methods: We conducted a retrospective review of clinical data from KD children with GCA referred to our institution between January 1998 and December 2023. GCA was defined as a CA diameter absolute value ≥8mm or Z-score ≥10. Preventive anticoagulation included Vitamin K antagonists (VKA) and aspirin in all patients. One-year CA imaging was performed using CA angiography or CT-scan. Cardiac events were defined as myocardial infarction, CA stenosis, thrombosis or occlusion, aneurysm of the left ventricle, or cardiac valvular lesions.

Results: We identified 60 patients with GCA (63.3% male). At diagnosis, the median age was 9.3 months (IQR, 4-29.7), and 56.7% had bilateral GCA. One-year CA imaging revealed normal CA in 30 (50%) patients, remaining non-giant coronary aneurysms in 11 (18.3%) patients, and GCA persistence in 19 (31.7%) patients. In univariate analysis, risk factors for GCA persistence were a baseline coronary diameter absolute value ≥8mm (OR: 17.5, 95% CI: 3.3-94.4, p 0.001), baseline CA diameter Z-score ≥18 (OR: 15.5, 95% CI: 2.9-82.8, p 0.001), and baseline bilateral GCA (OR: 10.4, 95% CI: 1.3-87.7, p 0.031). Over a median follow-up of 68.4 months (IQR 28.8-134.8), 13 cardiac events occurred in 11/60 (18.3%) patients, nine of whom had persistent GCA. At the last follow-up, 43/60 (71.7%) patients had non-giant aneurysm or normal CA. No deaths were reported.

Conclusion: In our experience, normalization and/or regression of GCA frequently occur in children with KD. However, children with persistent GCA are prone to cardiac events, emphasizing the need for long-term anticoagulation and close monitoring.