Stenotic Lesions and the Maximum Diameter of Coronary Artery Aneurysms in Kawasaki Disease.
Stenotic Lesions and the Maximum Diameter of Coronary Artery Aneurysms in Kawasaki Disease.
复制标题
川崎病的狭窄病变和冠状动脉瘤的最大直径。
DOI：
10.1016/j.jpeds.2017.09.077
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Hayama Y.
中科院分区：
文献类型：
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作者：
Tsuda E;Tsujii N;Hayama Y.
目的根据川崎患者最大冠状动脉瘤的最大直径和与发生狭窄病变风险相关的冠状动脉直径阈值，确定随后狭窄病变的患病率。研究对象为160名男性，在川崎发病后100天内进行选择性冠状动脉造影（CAG），发现至少有1个动脉瘤。我们测量了初始CAG中3个主要分支的冠状动脉瘤最大直径。根据冠状动脉瘤最大直径将分支分为3组：大，≥8.0 mm;中等，≥6.0 mm但<8.0 mm;小，<6.0 mm。在后期随访期间进行后续CAG。我们调查了随访CAG中的狭窄病变，并根据体表面积（BSA）采用Kaplan-Meier方法评估各组狭窄病变的患病率。本研究将局部狭窄≥25%和完全闭塞纳入狭窄病变。我们还确定了截止点狭窄insure.ResultsThe中位间隔从最初的CAG到最近的CAG是8年，最大的32年。对于BSA <0.50 m2的患者，20年大狭窄病变和中等狭窄病变的患病率分别为78%（n = 62; 95% CI，63-89）和81%（n = 40; 95% CI，63-89）。对于BSA ≥0.50 m2，大和中等狭窄病变为82%（n = 75; 95% CI，67-91）和40%（n = 56; 95% CI，20-64），分别（P< .0001）结论川崎发病后100天内冠状动脉内径的临界点是导致晚期冠状动脉狭窄的重要因素。直径≥6.1 mm且BSA <0.50 m2和直径≥8.0 mm且BSA ≥0.50 m2。这些截止点对应于二维超声心动图上的aZ评分至少为10。应对符合这些标准的患者进行仔细随访和抗血栓治疗。
ObjectivesTo determine the prevalence of subsequent stenotic lesions based on the maximum diameter of the largest coronary artery aneurysm in patients with Kawasaki disease and the threshold value of coronary artery diameter associated with risk of developing stenotic lesion.Study designThere were 214 patients (160 males) who had at least 1 aneurysm in a selective coronary angiogram (CAG) done <100 days after the onset of Kawasaki disease were studied. We measured the maximal coronary artery aneurysm diameter in 3 major branches in the initial CAGs. Branches were classified into 3 groups according to their maximal coronary artery aneurysm diameter: large, ≥8.0 mm; medium, ≥6.0 mm but <8.0 mm; and small, <6.0 mm. Subsequent CAGs were performed in the late follow-up period. We investigated the stenotic lesion in the follow-up CAGs, and evaluated the prevalence of stenotic lesion in each group based on body surface area (BSA) by the Kaplan-Meier method. Localized stenosis of ≥25% and complete occlusion were included as stenotic lesion in this study. We also determined the cutoff point for stenotic lesion.ResultsThe median interval from the initial CAGs to the latest CAG was 8 years, with a maximum of 32 years. For a BSA of <0.50 m2, the 20-year prevalence of large and medium stenotic lesions was 78% (n = 62; 95% CI, 63-89) and 81% (n = 40; 95% CI, 63-89), respectively. For a BSA of ≥0.50 m2, large and medium stenotic lesions were 82% (n = 75; 95% CI, 67-91) and 40% (n = 56; 95% CI, 20-64), respectively (P< .0001).ConclusionThe cutoff points of the coronary artery diameter within the first 100 days after the onset of Kawasaki disease leading to a stenotic lesion in the late period, were a diameter of ≥6.1 mm with a BSA of <0.50 m2and a diameter of ≥8.0 mm with a BSA of ≥0.50 m2. Those cutoff points would have corresponded with aZscore of at least 10 on 2-dimensional echocardiography. Careful follow-up and antithrombotic therapy should be provided to patients who meet these criteria.