Long-term cardiovascular outcomes and mortality following Kawasaki disease: A systematic review and meta-analysis

Objectives: To determine if children with Kawasaki disease (KD) are at an increased long-term risk of cardiovascular disease and mortality. Methods: A systematic review and meta-analysis was performed. A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane, and Web of Science databases was performed through 2022. English-language publications, patients 0 to 18 years at KD diagnosis, minimum follow-up >1 year, and ≥10 patients included. Of 5072 articles, 181 were included. Cardiovascular events and mortality were extracted and pooled for analysis. Meta-analyses and meta-regression analyses were performed. The primary outcome of interest was the incidence of specific cardiovascular events (composite of myocardial infarction, heart failure or cardiac arrest) and all-cause mortality. Secondary outcomes included the incidence of occlusive coronary events, myocardial infarction, heart failure, cardiac arrest, non-coronary artery bypass grafting (CABG) coronary revascularization procedures, and CABG. Results: Cardiovascular events occurred in 0.85% of children during study follow-up. The incidence rate of cardiovascular events was 370 per 100,000 person-years. Mortality occurred in 0.24% of children during study follow-up. The incidence rate of mortality was 117 per 100,000 person-years. Conclusions: There is a low incidence of cardiovascular events and mortality following childhood KD diagnosis. Further studies are needed to better define this long-term risk.