Risk stratification based on degree of coronary artery involvement.
Risk stratification in Kawasaki disease [2, 27, 35, 44, 45]
Description
Recommended action
Level 1
No coronary artery changes detected at any stage
No intervention required beyond 8 weeks after illness onset
Level 2
Patient exhibits transient coronary dilation that regresses within 8 weeks
No intervention required beyond 8 weeks after illness onset
Level 3
Echocardiography locates an isolated small aneurysm in 1 coronary artery
(i) Long-term antiplatelet therapy with low-dose aspirin until regression (ii) Annual electrocardiogram (ECG) and echocardiograph (iii) Biennial stress test with myocardial perfusion imaging if child >10 years old (iv) Angiography if ischaemia is implicated
Level 4
Echocardiography locates at least one large coronary artery aneurysm
(i) Long-term antiplatelet therapy with low-dose aspirin (ii) Adjunctive warfarin or heparin therapy (iii) Biennial echocardiograph and ECG (iv) Annual stress test (v) Cardiac catheterisation with coronary angiography within 6–12 months and repeated if ischaemia is implicated
Level 5
Coronary artery involvement has progressed to coronary artery obstruction
(i) Long-term antiplatelet therapy with aspirin (ii) Adjunctive warfarin or heparin therapy (iii) Beta blockers to reduce myocardial oxygen consumption (iv) Biannual echocardiograph and ECG (v) Annual stress test
