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Evaluating the time-varying risk of hypertension, cardiac events, and mortality following Kawasaki disease diagnosis

Lee JJY, Feldman BM, McCrindle BW, Li P, Yeung RS, Widdifield J. Pediatr Res. 2022; Aug 24 [Epub ahead of print]. DOI:

Background — This study evaluated the risk of hypertension, major adverse cardiac events (MACE), and all-cause mortality in Kawasaki disease (KD) patients up to young adulthood.

Methods — An inception cohort of 1169 KD patients between 1991 and 2008 from a tertiary-level hospital in Ontario, Canada was linked with health administrative data to ascertain outcomes up to 28 years of follow-up. Their risk was compared with 11,690 matched population comparators. The primary outcome was hypertension and secondary outcomes were MACE and death.

Results — After a median follow-up of 20 years [IQR: 8.3], the cumulative incidence of hypertension and MACE in the KD group was 3.8% (95% CI: 2.5–5.5) and 1.2% (95% CI: 0.6–2.4%), respectively. The overall survival probability in the KD group was 98.6% (95% CI: 97.2–99.3%). Relative to comparators, KD patients were at an increased risk for hypertension [aHR: 2.2 (95% CI: 1.5–3.4)], death [aHR: 2.5 (95% CI: 1.3–5.0)], and MACE [aHR: 10.7 (95% CI: 6.4–17.9)]. For hypertension and MACE, the aHR was the highest following diagnosis and then the excess risk diminished after 16 and 13 years of follow-up, respectively. MACE occurred largely in KD patients with coronary aneurysms [cumulative incidence: 12.8%].

Conclusions — KD patients demonstrated a reassuring cardiac prognosis up to young adulthood with low events and excellent survival. KD patients were at increased risk for hypertension, but this excess risk occurred early and declined with time.