Evaluating the time-varying risk of hypertension, cardiac events, and mortality following Kawasaki disease diagnosis.
Pediatr Res
; 93(5): 1439-1446, 2023 04.
Article
em En
| MEDLINE
| ID: mdl-36002584
ABSTRACT
BACKGROUND:
This study evaluated the risk of hypertension, major adverse cardiac events (MACE), and all-cause mortality in Kawasaki disease (KD) patients up to young adulthood.METHODS:
An inception cohort of 1169 KD patients between 1991 and 2008 from a tertiary-level hospital in Ontario, Canada was linked with health administrative data to ascertain outcomes up to 28 years of follow-up. Their risk was compared with 11,690 matched population comparators. The primary outcome was hypertension and secondary outcomes were MACE and death.RESULTS:
After a median follow-up of 20 years [IQR 8.3], the cumulative incidence of hypertension and MACE in the KD group was 3.8% (95% CI 2.5-5.5) and 1.2% (95% CI 0.6-2.4%), respectively. The overall survival probability in the KD group was 98.6% (95% CI 97.2-99.3%). Relative to comparators, KD patients were at an increased risk for hypertension [aHR 2.2 (95% CI 1.5-3.4)], death [aHR 2.5 (95% CI 1.3-5.0)], and MACE [aHR 10.7 (95% CI 6.4-17.9)]. For hypertension and MACE, the aHR was the highest following diagnosis and then the excess risk diminished after 16 and 13 years of follow-up, respectively. MACE occurred largely in KD patients with coronary aneurysms [cumulative incidence 12.8%].CONCLUSIONS:
KD patients demonstrated a reassuring cardiac prognosis up to young adulthood with low events and excellent survival. KD patients were at increased risk for hypertension, but this excess risk occurred early and declined with time. IMPACT With the current standard of care, KD patients demonstrated favorable cardiac prognosis, with low events of hypertension, MACE, and excellent survival. Hypertension and MACE risk appear to be highest around the time of KD diagnosis. MACE occurred primarily in KD patients with coronary aneurysms. Our findings are reassuring to KD patients, families, and their providers. Our study demonstrated an association between KD exposure and hypertension. This association is relatively novel. Previous studies have remained conflicting if KD contributes to long-term atherosclerotic risk.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Aneurisma Coronário
/
Hipertensão
/
Síndrome de Linfonodos Mucocutâneos
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Pediatr Res
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Canadá