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

Cal Robinson; Rahul Chanchlani; Anastasia Gayowsky; Sandeep Brar; Elizabeth Darling; Catherine Demers; Tapas Mondal; Rulan Parekh; Hsien Seow; Michelle Batthish

doi:10.1038/s41390-022-02391-3

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

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

Authors

Cal Robinson^{1

2}, Rahul Chanchlani^{3

4

5}, Anastasia Gayowsky⁵, Sandeep Brar⁶, Elizabeth Darling⁷, Catherine Demers⁸, Tapas Mondal⁹, Rulan Parekh², Hsien Seow¹⁰, Michelle Batthish¹¹

Affiliations

¹ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
² Division of Nephrology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
³ Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁵ ICES McMaster, Hamilton, ON, Canada.
⁶ Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
⁷ McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada.
⁸ Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁹ Division of Cardiology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Oncology, McMaster University, Hamilton, ON, Canada.
¹¹ Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada. batthim@mcmaster.ca.

PMID: 36380069
DOI: 10.1038/s41390-022-02391-3

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aftercare
Cardiovascular Diseases* / epidemiology
Child
Cohort Studies
Humans
Mucocutaneous Lymph Node Syndrome* / complications
Patient Discharge
Retrospective Studies
Risk Factors