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. 2023 Apr;93(5):1267-1275.
doi: 10.1038/s41390-022-02391-3. Epub 2022 Nov 15.

Cardiovascular outcomes in children with Kawasaki disease: a population-based cohort study

Cal Robinson  1   2 , Rahul Chanchlani  3   4   5 , Anastasia Gayowsky  5 , Sandeep Brar  6 , Elizabeth Darling  7 , Catherine Demers  8 , Tapas Mondal  9 , Rulan Parekh  2 , Hsien Seow  10 , Michelle Batthish  11
Affiliations

Cardiovascular outcomes in children with Kawasaki disease: a population-based cohort study

Cal Robinson et al. Pediatr Res. 2023 Apr.

Abstract

Background: The risk of cardiovascular events after Kawasaki disease (KD) remains uncertain. Our objective was to determine the risk of cardiovascular events and mortality after KD.

Methods: Population-based retrospective cohort study using Ontario health administrative databases (0-18 years; 1995-2018).

Exposure: pediatric KD hospitalizations. Each case was matched to 100 non-exposed controls.

Primary outcome: major adverse cardiac events (MACE; cardiovascular death, myocardial infarction, or stroke composite).

Secondary outcomes: composite cardiovascular events and mortality. We determined incidence rates and adjusted hazard ratios (aHR) using multivariable Cox models.

Results: Among 4597 KD survivors, 79 (1.7%) experienced MACE, 632 (13.8%) composite cardiovascular events, and 9 (0.2%) died during 11-year median follow-up. The most frequent cardiovascular events among KD survivors were ischemic heart disease (4.6 events/1000 person-years) and arrhythmias (4.5/1000 person-years). KD survivors were at increased risk of MACE between 0-1 and 5-10 years, and composite cardiovascular events at all time periods post-discharge. KD survivors had a lower mortality risk throughout follow-up (aHR 0.36, 95% CI 0.19-0.70).

Conclusion: KD survivors are at increased risk of post-discharge cardiovascular events but have a lower risk of death, which justifies enhanced cardiovascular disease surveillance in these patients.

Impact: Among 4597 Kawasaki disease (KD) survivors, 79 (1.7%) experienced major adverse cardiac events (MACE) and 632 (13.8%) had composite cardiovascular events during 11-year median follow-up. KD survivors had significantly higher risks of post-discharge MACE and cardiovascular events versus non-exposed children. Only nine KD survivors (0.2%) died during follow-up, and the risk of mortality was significantly lower among KD survivors versus non-exposed children. Childhood KD survivors should receive preventative counseling and cardiovascular surveillance, aiming to mitigate adult cardiovascular disease.

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References

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    1. Robinson, C. et al. Incidence and short-term outcomes of Kawasaki disease. Pediatr. Res. 90, 670–677. https://doi.org/10.1038/s41390-021-01496-5 (2021).
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