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Comparative Study
. 2013 Oct 9;168(4):3825-8.
doi: 10.1016/j.ijcard.2013.06.027. Epub 2013 Jul 11.

Coronary artery outcomes among children with Kawasaki disease in the United States and Japan

Affiliations
Comparative Study

Coronary artery outcomes among children with Kawasaki disease in the United States and Japan

Shohei Ogata et al. Int J Cardiol. .

Abstract

Objective: It has been claimed that the aneurysm rate for Kawasaki disease (KD) patients in Japan is lower than in the U.S. However it has been difficult to compare coronary artery (CA) outcomes between the two countries because of different definitions for CA abnormalities. Therefore, we compared CA internal diameters between Japanese and U.S. KD patients using standard definitions and methods.

Study design: We retrospectively reviewed CA outcomes in 1082 KD patients from 2 centers in the U.S. and 3 centers in Japan and compared Z-max scores (maximum internal diameter for the left anterior descending or right coronary artery expressed as standard deviation units from the mean (Z-score) normalized for body surface area) obtained within 12 weeks after onset and calculated using two different regression equations from Canada (Dallaire) and Japan (Fuse). We defined a Z-max of < 2.5 as normal and a Z-max of ≥ 10 as giant aneurysm.

Result: The median Z-max for the U.S. and Japanese subjects was 1.9 and 2.3 SD units, respectively (p < 0.001). There was no significant difference in rates of patients with Z-max ≥ 5.0 between the countries. In a multivariable model adjusting for age, sex, and treatment response, being Japanese was still associated with a higher Z-max score.

Conclusion: Previously reported differences in aneurysm rates between Japan and the U.S. likely resulted from use of different definitions and nomenclature. Adoption of Z-scores as a standard for reporting CA internal diameters will allow meaningful comparisons among different countries and will facilitate international, collaborative clinical trials.

Keywords: Coronary artery aneurysm; Echocardiography; Kawasaki disease; Vasculitis; Z score.

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Conflict of interest statement

Potential conflicts of interest: None

Figures

Fig 1
Fig 1
Coronary artery outcomes for Kawasaki disease subjects in the U.S. and Japan calculated using the Haycock BSA equation and Dallaire equation for Z-max. Box plots represent the median and 25-75th percentiles, whiskers represent the 5-95%, and outliers are shown as open circles.
Fig. 2
Fig. 2
Distribution of Z-max in the U.S. and Japan using the Fuse and Dallaire equations for Z-scores. Z-max was categorized as follows: <2.5 (White), ≥2.5 (Gray) and <5.0, and ≥5.0 (Black). Body surface area was calculated by the Du Bois equation. (A) Distribution of Z-max using the Fuse Z-score. (B) Distribution of Z-max using the Dallaire Z-score. No significant difference was noted for either comparison.

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