CORONARY-ARTERY DIMENSIONS MAY BE MISCLASSIFIED AS NORMAL IN KAWASAKI-DISEASE

Background: Current American Heart Association guidelines indicate tha t patients with Kawasaki disease and no coronary artery abnormalities on echocardiography at any stage of illness may be discharged from car diologic follow-up 1 year after onset of illness. Methods and Results: To determine whether coronary artery dimensions in patients with Kawa saki disease whose vessels are classified as ''normal'' by Japanese Mi nistry of Health criteria have a distribution similar to expected popu lation norms when adjusting for body surface area, we studied 125 pati ents during 4 intervals from onset of illness: (1) 10 days or less, (2 ) 2 weeks (11 to 21 days), (3) 6 weeks (22 days to 3 months), and (4) 1 year (4 months to 1.5 years). Using two-dimensional echocardiography , we measured the internal lumen diameter of the left main, proximal l eft anterior descending, and proximal right coronary arteries. Mean bo dy surface area-adjusted dimensions of the proximal left anterior desc ending and right coronary arteries were significantly larger (P < .01) in patients with Kawasaki disease than those in subjects in all perio ds, except for a marginal difference at 6 weeks for the proximal right coronary artery (P = .02); for the left main coronary artery this dif ference achieved statistical significance in the period of 10 days or less, with a trend at 2 weeks (P = .02). Among patients classified as having normal coronary arteries on all echocardiograms by the Japanese Ministry of Health criteria, 27% had at least 1 body surface area-adj usted coronary dimension more than 2 standard deviations above the exp ected mean. Conclusions: Coronary artery dilation in Kawasaki disease is thus more prevalent than previously reported, highlighting the need for systematic long-term surveillance of this population.