Intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD) has been shown to reduce coronary artery aneurysm by 4-5%. However, we still observed significant number of coronary aneurysm post IVIG in our centre. The objectives of this study were to determine the prevalence of coronary artery abnormality (CAA) and the associated risk factors.
Designs: Retrospective descriptive study. Method: A retrospective study performed on children with KD from 1 st January 2005 to 30 th July 2010. Japanese Ministry of Health criteria were used to classify coronary arteries abnormality. Children with incomplete or atypical KD were excluded. Data were extracted from Pediatric Cardiology Clinical Information System.
Results: A total of 126 KD were diagnosed during the study period with 69% were male and 52.4% were Chinese. The median age of diagnosis was 1.4yr [Q1, 0.6yr Q3, 2.3yr]. Of these 126, 118 (93.7%) received IVIG within 10 days of illness. Ten patients (7.9%) required more than one dose of IVIG. CAA were noted in 28 (22.2%) patients with 21 ectasia, 4 small fusiform, one small saccular and 2 medium fusiform aneurysm. Of these 28, 22 who had IVIG within 10 days of illness (18 ectasia, 3 small and one medium coronary aneurysm) Significant risk factors for CAA were older children (2.3 v s 1.7yr, p=0.03), presentation after 10days of illness (p=0.006) and required more than 2gm/kg of IVIG (p=0.04).
Conclusion: CAA in complete KD treated with IVIG was 22.2% with 5.5% significant aneurysm. Risk factors for coronary abnormality were older children, late presentation and require more of IVIG of than 2gm/kg.