Clinical Analysis And Follow-Up Of Kawasaki Disease Complicated With Coronary Atrery Thrombosis In 50 Cases

Objective:To investigate the high risk factors, diagnosis,treatment and prognosis of Kawasaki disease (KD) complicated with coronary artery thrombosis (CAT)Methods:Totally 3313 patients were diagnosed with KD in the Children’s Hospital of Chongqing Medical University from 2010 to 2014, 50 of whom complicated with CAT.Clinical features, result of auxiliary examinations, treatment and long-term followed-up results of these 50 cases were retrospectively reviewed in our institute.616 cases without CAT in the 3313 KD were selected randomly as case-control group, and high risk factors for CAT were analyzed.Results:1.The incidence of CAT in patients with KD was 1.51% (50/3313) in our hospital from 2010 to 2014.The male to female ratio of 50 CAT cases was 2.57:1, and the median age was 1.7 years.Incidence of KD complicated with CAT was on the rise in recent years.50 patients with CAT including 15 cases complicated with giant coronary artery aneurysm (GCAA),32 cases complicated with medium coronary artery aneurysm and 3 cases complicated with coronary artery dilatation (CAD).The thrombi were located mainly in left anterior descending coronary artery (LDA)2.The form of coronary artery aneurysm (CAA), accepting the fist intravenous immunoglobulin (IVIG) later than lOd to first fever, ESR>100mm/h, age<1year, PLT>800×l012/L, course of fever>14d, Hb<90g/L were associated with CAT. Multivariable logistic regression model analysis showed that the form of CAA [OR=335.998,95%CI (75.825,1488.879)], accepting the fist IVIG later than 10d to first fever[OR=14.730,95%CI(1.765,122.919)], ESR>100mm/h[OR=6.789, 95%CI (1.283,35.924)] were the independent risk factors of CAT.3.10 of the 50 CAT patents accepted intravenous coronary thrombolysis therapy and 2 cases were effective.Follow-up survey was performed in 39 CAT cases, and the thrombi were resolved (totally or partly) in 21cases, remain unchanged or aggravated in 18 cases.35 of the 39 cases had no characteristic clinical manifestations. The rest 4 cases were diagnosed with myocardial infarction by electrocardiogram and 3 of them complicated with heart failure.No death occurred in all follow-up patents.Conclusions:KD complicated with CAT mainly occurred in patients complicated with CAA and mostly had no special clinical manifestation in acute phase.The form of CAA, accepting the fist IVIG later than 10d to course of fever, ESR>100mm/h were the independent risk factors of CAT.There were no specific guideline for management of CAT and partial patients were with poor prognosis although under regular treatment.