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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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

期刊介绍： The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.