Cardiovascular outcomes in children with Kawasaki disease: a population-based cohort study

BackgroundThe risk of cardiovascular events after Kawasaki disease (KD) remains uncertain. Our objective was to determine the risk of cardiovascular events and mortality after KD.MethodsPopulation-based retrospective cohort study using Ontario health administrative databases (0–18 years; 1995–2018). Exposure: pediatric KD hospitalizations. Each case was matched to 100 non-exposed controls. Primary outcome: major adverse cardiac events (MACE; cardiovascular death, myocardial infarction, or stroke composite). Secondary outcomes: composite cardiovascular events and mortality. We determined incidence rates and adjusted hazard ratios (aHR) using multivariable Cox models.ResultsAmong 4597 KD survivors, 79 (1.7%) experienced MACE, 632 (13.8%) composite cardiovascular events, and 9 (0.2%) died during 11-year median follow-up. The most frequent cardiovascular events among KD survivors were ischemic heart disease (4.6 events/1000 person-years) and arrhythmias (4.5/1000 person-years). KD survivors were at increased risk of MACE between 0–1 and 5–10 years, and composite cardiovascular events at all time periods post-discharge. KD survivors had a lower mortality risk throughout follow-up (aHR 0.36, 95% CI 0.19–0.70).ConclusionKD survivors are at increased risk of post-discharge cardiovascular events but have a lower risk of death, which justifies enhanced cardiovascular disease surveillance in these patients.ImpactAmong 4597 Kawasaki disease (KD) survivors, 79 (1.7%) experienced major adverse cardiac events (MACE) and 632 (13.8%) had composite cardiovascular events during 11-year median follow-up.KD survivors had significantly higher risks of post-discharge MACE and cardiovascular events versus non-exposed children.Only nine KD survivors (0.2%) died during follow-up, and the risk of mortality was significantly lower among KD survivors versus non-exposed children.Childhood KD survivors should receive preventative counseling and cardiovascular surveillance, aiming to mitigate adult cardiovascular disease.