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

IF 3 3区医学 Q1 PEDIATRICS

European Journal of Pediatrics Pub Date : 2024-11-01 Epub Date: 2024-09-06 DOI:10.1007/s00431-024-05765-3

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

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引用次数: 0

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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肾素-血管紧张素-醛固酮系统抑制剂对患有冠状动脉瘤的川崎病患者的消退作用：一项前瞻性观察研究。

目的：本研究旨在探讨血管紧张素 1 型受体阻滞剂（ARB）或血管紧张素转换酶抑制剂（ACEis）是否能缓解川崎病（KD）患者的冠状动脉瘤（CAA）：这项多中心、前瞻性、观察性研究在日本全国 53 家机构进行。我们招募了 2015 年 1 月后确诊为 KD 的患者，这些患者在 KD 发病后 30 天或之后出现中型或大型 CAA（最大管腔直径≥ 4 毫米或 z 评分≥ + 5）：在209名患者中，47人（22%）服用了ARBs/ ACEis。与非 ARB/ACEi 组患者相比，基线 CAA 直径明显增大（6.7 毫米对 5.5 毫米，P 结论：虽然 ARB/ACEi 组患者的基线 CAA 直径比非 ARB/ACEi 组患者的基线 CAA 直径小，但与非 ARB/ACEi 组患者相比，基线 CAA 直径明显增大：虽然严重 CAA 患者更常使用 ARBs/ACEis，但这些患者的 CAA 消退率与未使用 ARBs/ACEis 的患者相似。ARBs/ACEis可能是诱导KD患者CAA消退的有益药物：- 大面积 CAA 消退的可能性较小，并且始终存在发生危及生命的心脏事件的风险。- 据报道，中度 CAA、年龄小于 1 岁和女性是促进 CAA 消退的因素：- 尽管ARBs/ACEis在重度CAA患者中使用更频繁，但这些患者的CAA消退率与未服用ARBs/ACEis的患者相似。- ARB/ACEi组的巨大CAA消退率约为未服用ARB/ACEi组的1.6倍。

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来源期刊

European Journal of Pediatrics 医学-小儿科

CiteScore

5.90

自引率

2.80%

发文量

367

审稿时长

3-6 weeks

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