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06-09-2024 | Kawasaki Disease | RESEARCH

Regression effect of renin–angiotensin–aldosterone system inhibitors on Kawasaki disease patients with coronary artery aneurysm: a prospective, observational study

Authors: Eisuke Suganuma, Masaru Miura, Yutaro Koyama, Tohru Kobayashi, Tetsuji Kaneko, Tatsunori Hokosaki, Fujito Numano, Kenji Furuno, Junko Shiono, Shigeto Fuse, Ryuji Fukazawa, Yoshihide Mitani

Published in: European Journal of Pediatrics

Abstract

Purpose

This study is to investigate whether angiotensin type 1 receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEis) can regress coronary artery aneurysm (CAA) in patients with Kawasaki disease (KD).

Methods

This multicenter, prospective, observational study was conducted at 53 institutions throughout Japan. We enrolled patients who were diagnosed with KD after January 2015 and had a medium or large CAA (maximum luminal diameter ≥ 4 mm or z score ≥ + 5) 30 days or later after KD onset.

Results

Of the 209 patients, 47 (22%) were taking ARBs/ ACEis. Compared with those in the non-ARB/ACEi group, the baseline CAA diameter was significantly greater (6.7 mm vs. 5.5 mm, p < 0.01), and bilateral CAA (70% vs. 59%, p = 0.01) and giant CAA (32% vs. 20%, p = 0.08) were more frequently observed in the ARB/ACEi group. Although the overall regression rates did not differ between the groups (67% vs. 65%), the regression rates of giant CAA were approximately 1.6 times greater in the ARB/ACEi group than in the non-ARB/ACEi group (36% vs. 23%). Multivariate Cox regression analysis after adjustment for other clinical variables suggested that ARBs/ACEis may be a factor in CAA regression (hazard ratio [HR]: 1.5, 95% confidence interval [CI]: 0.91–2.46).

Conclusions

Although ARBs/ ACEis were used more frequently in patients with severe CAA, these patients had similar CAA regression rates to patients not taking ARBs/ACEis. ARBs/ACEis may be beneficial agents aimed at inducing CAA regression in KD patients.

What is Known:

• Large CAAs are less likely to regress and are always at risk of life-threatening cardiac events.

• Moderate CAA, age less than 1 year, and female sex have been reported to be factors that promote the regression of CAA.

What is New:

• Although ARBs/ACEis were used more frequently in patients with severe CAA, these patients had a similar rate of CAA regression to patients who did not take ARBs/ACEis.

• The regression rates of giant CAA were approximately 1.6 times greater in the ARB/ACEi group than in the non-ARB/ACEi group.

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Title: Regression effect of renin–angiotensin–aldosterone system inhibitors on Kawasaki disease patients with coronary artery aneurysm: a prospective, observational study
Authors: Eisuke Suganuma
Masaru Miura
Yutaro Koyama
Tohru Kobayashi
Tetsuji Kaneko
Tatsunori Hokosaki
Fujito Numano
Kenji Furuno
Junko Shiono
Shigeto Fuse
Ryuji Fukazawa
Yoshihide Mitani
Publication date: 06-09-2024
Publisher: Springer Berlin Heidelberg
Keywords: Kawasaki Disease
Kawasaki Disease
Kawasaki Disease
Aneurysm
Unruptured Cerebral Aneurysm
Psychodynamic Regression
Published in: European Journal of Pediatrics
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-024-05765-3

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Regression effect of renin–angiotensin–aldosterone system inhibitors on Kawasaki disease patients with coronary artery aneurysm: a prospective, observational study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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