94 - FOLLOW-UP OF 112 CHILDREN WITH KAWASAKI DISEASE COMPLICATED WITH GIANT CORONARY ARTERY ANEURYSM

Objective To summarize the middle‑and long‑term prognosis of Kawasaki disease (KD) with giant coronary artery aneurysm (GCAA) in a single center of China.

Methods A cross‑sectional analysis was conducted on 112 KD children with GCAA in the KD with GCAA database established by Beijing Children′s Hospital in 2004. GCAA was diagnosed as coronary artery absolute lumen diameter ≥8.0 mm. All children were followed regularly.

Results A total of 112 KD children with GCAA were enrolled, including 91 males (81.2%) and 21 females (18.8%). The age of disease onset was 2.5 (1.0, 4.6) years. The follow‑up duration was 5.2 (2.7, 8.6) years, with a longest of 22 years. All children received routine treatment with aspirin and warfarin, and clopidogrel was added in severe cases. At the end of follow‑up, 14 children (12.5%) had cardiac enlargement, 13 (11.6%) developed heart failure, 14 (12.5%) experienced myocardial infarction, 4 (3.6%) underwent coronary artery bypass graft and 6 children (5.4%) died. A total of 191 coronary arteries were involved, including 27 (14.1%) GCAAs on the main trunk of left coronary artery, 108 (56.4%) GCAAs on left anterior descending, 11 (5.8%) GCAAs on left circumflex and right coronary, 88 (46.1%) GCAAs on the middle segments of right coronary artery, and 1 (0.1%) GCAA in the distal segments of right coronary artery. By the end of our study, the maximum diameter of GCAAs had different degrees of retraction compared with the starting point of follow‑up (all P<0.05), 12 children (10.7%) recovered with the coronary artery absolute lumen diameter of all GCAAs below 4.0 mm. Among 191 segments  with GCAAs, 32 (16.8%) regressed below 4.0 mm. No significant difference was found in the regression rates between right and left GCAA (18.7% vs 13.9%, χ²=2.383, P=0.123). There was no statistically significant difference in retraction between unilateral GCAA and bilateral GCAA (16.6% vs 4.4%, χ2=2.126, P=0.141).

Conclusions GCAA of KD occurred more common in the middle segments of right and left anterior descending coronary arteries. The incidences of adverse cardiac events and the mortality rates in children with GCAA complicated with KD were significant. The long term prognosis was poor.