Japan: A study of Journal of the American Heart Association has mentioned the association between Coronary Arterial Aneurysm (CAA) severity classified by the z score of coronary arterial internal diameter in the acute phase with the CAA regression rate.
This study is the one with the longest follow-up of CAA.
The researchers mentioned that during the long-term follow-up period, the factors associated with regression were Small CAAs, diagnosis under the age of 1 year, the onset of Kawasaki disease and right coronary artery CAA in females.
The data contribute to the regression mechanism and long-term treatment of CAA based on severity.
Kawasaki disease is a commonly acquired cardiovascular disease. The prognosis is affected by CAA, the most important sequela of the disease, with an incidence of 20% to 25% before immunoglobulin use.
CAA patients are at risk of angina pectoris or myocardial infarction due to stenosis of coronary disease. These patients are usually treated with warfarin.
Researchers reported that CAA classification by z score of the internal diameter relates to cardiac event risk.
The knowledge of regression and associated factors still needs to be improved.
Considering this, researchers used z-score classification to examine CAA regression and its associated factors.
The study points include the following:
- The cohort involved 44 institutions in Japan.
- A total of 1006 patients had KD.
- Z- score classification, based on internal diameter in the acute phase, was small (z<5), medium (5≤z<10), and large (z≥10).
- For the right coronary artery, after ten years, CAA regression rates were 95.5 %, 83.2 % and 36.3 % for small, medium and large.
- After ten years, in the proximal left anterior descending artery, the regression rates following diagnosis were 95.3%, 80.1% and 28.8% for small, medium and large.
- The diagnosis was under the age of 1 year, and KD onset in for the right coronary artery and the left anterior descending artery, and female for the right coronary artery had a high regression rate.
- There was a low regression rate in large CAAs for the right coronary artery and the left anterior descending artery.
To conclude, small aneurysms, recent onset, and diagnosis under the age of 1 year predict regression, and even giant aneurysms could regress.
The data of this study is vital for the long‐term management of coronary aneurysms.
Limitations of the study include a lower limit of small CAA, retrospective design, non-standardized timing of coronary angiography and not including other ethnic groups.
Further reading:
Kato, Taichi, et al. “Analysis of Coronary Arterial Aneurysm Regression in Patients With Kawasaki Disease by Aneurysm Severity: Factors Associated With Regression.” Journal of the American Heart Association, vol. 12, no. 3, Ovid Technologies (Wolters Kluwer Health), Feb. 2023. Crossref, https://doi.org/10.1161/jaha.121.022417.