Spectrum of Coronary Artery Involvement With Multisystem Inflammatory Syndrome in Children Versus Kawasaki Disease

Simon Lee, Ann & Robert H. Lurie Children's Hospital of Chicago IL USA.
Ashraf S. Harahsheh, Children's National Hospital The George Washington University School of Medicine & Health Sciences Washington DC USA.
Geetha Raghuveer, Children's Mercy Hospital Kansas City MO USA.
Michael A. Portman, Seattle Children's Research Institute Seattle WA USA.
Arash A. Sabati, Phoenix Children's Phoenix AZ USA.
Michael Khoury, Department of Pediatrics University of Alberta Edmonton AB Canada.
Nagib Dahdah, Division of Pediatric Cardiology, CHU Sainte-Justine University of Montreal QC Canada.
Marianna Fabi, Pediatric Emergency Unit IRCCS Azienda Ospedaliero-universitaria di Bologna Italy.
Supriya S. Jain, New York Medical College - Maria Fareri Children's Hospital at Westchester Medical Center New York Valhalla NY USA.
Audrey Dionne, Department of Cardiology, Boston Children's Hospital, Department of Pediatrics Harvard Medical School Boston MA USA.
Kyle Runeckles, Ted Rogers Computational Program, Peter Munk Cardiac Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children University Health Network Toronto ON Canada.
Frederic Dallaire, Universite de Sherbrooke and Centre de recherche du Centre hospitalier universitaire de Sherbrooke QC Canada.
Nadine F. Choueiter, Childrens Hospital at Montefiore Bronx NY USA.
Tyler H. Harris, UPMC Children's Hospital of Pittsburgh PA USA.
Matthew D. Elias, Division of Cardiology Children's Hospital of Philadelphia PA USA.
Anji T. Yetman, Children's Nebraska Omaha NE USA.
Balasubramanian Sundaram, Kanchi Kamakoti Childs Trust Hospital Chennai India.
Luis M. Garrido-Garcia, Instituto Nacional de Pediatria Mexico City Mexico.
Nilanjana Misra, Cohen Children's Medical Center of NY, Northwell Health Queens NY USA.
Cedric Manlhiot, Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University Baltimore MD USA.
Pedrom Farid, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics University of Toronto ON Canada.
Brian W. McCrindle, Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics University of Toronto ON Canada.

Document Type

Journal Article

Publication Date

4-23-2025

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.124.037761

Keywords

Kawasaki disease; Kawasaki disease registry; coronary aneurysm

Abstract

BACKGROUND: There is significant overlap in clinical features between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD). We sought to compare the prevalence, severity, and associated factors for coronary artery (CA) involvement. METHODS AND RESULTS: From January 1, 2020 through January 31, 2023, 1191 patients with MIS-C and 554 patients contemporaneously diagnosed with KD were enrolled into the International Kawasaki Disease Registry. Demographic and clinical features, laboratory values, maximum Z score in any CA branch at any time point, and worst left ventricular ejection fraction, were compared between groups. Factors associated with CA aneurysms (maximum Z score in any CA branch +2.5 or greater) were determined separately for each diagnosis using multivariable logistic regression analyses. The prevalence of CA aneurysms was lower for MIS-C versus KD (16% versus 25%, respectively; P<0.001) and less severe by size category (1.2% with medium/large CA aneurysm versus 9.6%, respectively). Male sex and lower nadir hemoglobin levels were associated with greater odds of CA aneurysms for both groups. Additional associated factors for KD patients included age<6 months, fewer clinical KD criteria (more incomplete presentation), presentation with shock, and greater total days of fever. There were no additional associated factors for patients with MIS-C. Using exploratory splines, there was a trend of improvement in Z scores within 30 days of illness for both MIS-C and KD for CA involvement other than large aneurysms. CONCLUSIONS: CA involvement for patients with MIS-C was less prevalent and milder in severity compared with contemporaneous patients with KD, with fewer associated factors, and a high prevalence of regression to a normal luminal dimension.

Department

Pediatrics

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