Acute Phase Treatment for Prevention of Coronary Artery Stenosis Caused in Kawasaki Disease: A Single Center Retrospective Study

Toshimasa Nakada


Background: The acute phase treatment to prevent coronary artery stenosis have not been established in Kawasaki disease (KD). Objective: To ascertain the outcomes of coronary artery lesions (CAL) in patients who received an initial intravenous immunoglobulin (IVIG) therapy (2 g/kg) with delayed use of aspirin (DUA) for KD.

Materials and Methods: The outcomes in 201 patients who underwent initial IVIG therapy at 2 g/kg/dose with DUA for KD were investigated retrospectively. The patients who received flurbiprofen instead of aspirin were also included. These subjects were divided into those who were associated with CAL (CAL group, n = 4) and those without CAL (non-CAL group, n = 197). Statistical analyses were performed using Stat Flex Version 6 for Windows (Artech Co., Ltd., Osaka, Japan). Chi-square, Fisher’s exact, and Mann–Whitney U tests were used as appropriate, with sample size considerations.

Results: The prevalence of resistant patients and those who required rescue therapies in the CAL group were significantly higher than those in non-CAL group (75.0% vs. 21.3%, P = 0.036 and 75.0% vs. 11.1%, P = 0.006, respectively). The values of neutrophil to lymphocyte ratio (NLR) after initial IVIG therapy in CAL group were significantly higher than those in non-CAL group (median: 5.91, range: 1.01-12.65 vs. 0.87, 0.01-11.29, P = 0.013). The one patient in CAL group who required plasma exchange had the highest value of the NLR. No patient had the large CAL>6.0 mm with high-risk for stenosis, and only one patient had persistent CAL of moderate-sized solitary right coronary artery at 60th day of illness.

Conclusion: An initial IVIG therapy (2 g/kg) with DUA may be useful for prevention of coronary artery stenosis caused in KD.


Aspirin, Coronary artery lesions, Intravenous immunoglobulin therapy, Kawasaki disease

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