川崎病患者的长期心血管风险低

洛杉矶——美国心脏协会(AHA)年会上公布的一项美国研究显示，546例儿童急性川崎病存活患者在平均15年随访期间的心血管事件发生率极低，与2218例匹配的对照者无差异。

这项研究由旧金山凯撒医学中心的Taylor J. Holve博士及其同事开展，是迄今同类型研究中规模最大的一项。复合终点事件包括急性冠脉综合征、冠状动脉血运重建、心力衰竭、室性心律失常、心脏瓣膜疾病、主动脉瘤或全因死亡。川崎病组2例患者和对照组7例患者发生复合终点事件，据此计算出川崎病组校正的事件发生率为0.246起事件/1000人-年，对照组为0.217起事件/1000人-年。

川崎病组25例患者存在持续性冠状动脉瘤，其中2例患者在长期随访期间出现心血管事件，1例为急性冠脉综合征，另1例为冠状动脉旁路移植术后发生的冠脉综合征。

该研究表明，持续性冠状动脉瘤存活患者是风险较高的亚组，需予以长期心血管监测。相比之下，无持续性动脉瘤的川崎病存活患者的心血管事件发生率为0。值得注意的是，这些患者在随访15年时的平均年龄稍大于21岁，有必要对患者进行进一步随访，以观察无持续性冠状动脉瘤的患者在达到25岁以后其心血管事件风险是否仍处于低水平或升高。

用于治疗急性川崎病的各种治疗策略与近期或远期并发症发生率无关。

Holve博士声明无经济利益冲突。

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By: BRUCE JANCIN, Cardiology News Digital Network

LOS ANGELES – The largest-ever U.S. study of the long-term risk of cardiovascular events in survivors of childhood acute Kawasaki disease paints a highly reassuring picture overall.

Indeed, the cardiovascular event rate in 546 patients during an average 15-year follow-up since their acute illness was extremely low – no different, in fact, than in 2,218 matched controls, Dr. Taylor J. Holve reported at the annual scientific sessions of the American Heart Association.

The composite endpoint of acute coronary syndrome, coronary revascularization heart failure, ventricular arrhythmia, valvular heart disease, aortic aneurysm, or all-cause mortality occurred in two patients with a history of Kawasaki disease and in seven controls. That translated to an adjusted incidence rate of 0.246 events per 1,000 person-years in the Kawasaki disease group and a similar figure of 0.217 per 1,000 person-years in controls, according to Dr. Holve of Kaiser San Francisco Medical Center.

Twenty-five patients in the Kawasaki disease group had a persistent coronary artery aneurysm. Both of the cardiovascular events that occurred during long-term follow-up – one case of acute coronary syndrome (ACS), and another of ACS followed by coronary artery bypass surgery – were in the small subgroup with persistent coronary aneurysm.

Other investigators have previously described the increased long-term risk posed by formation of a persistent aneurysm in survivors of acute Kawasaki disease. It’s clear from this large study that survivors with persistent coronary aneurysm are a higher-risk subgroup meriting long-term cardiovascular surveillance. In contrast, Kawasaki disease survivors without persistent aneurysm had a cardiovascular event rate of zero. A caveat: The average age of these patients at 15 years of follow-up was slightly over 21 years; continued follow-up will be required to exclude the possibility of an elevated risk of cardiovascular events once patients without a persistent coronary aneurysm hit their mid-20s and beyond, Dr. Holve noted.

The various treatment strategies employed in treating acute Kawasaki disease showed no association with short- or long-term complication rates.

Dr. Holve reported having no financial conflicts.