Table 4 Cardiovascular risk stratification for patients with Kawasaki syndrome
From: Kawasaki syndrome: an intriguing disease with numerous unsolved dilemmas
Risk level | Therapy | Physical activity | Follow-up | Invasive testing |
|---|---|---|---|---|
I (no coronary artery changes) | None beyond first 6-8 weeks | No restrictions beyond first 6-8 weeks | Counseling at 5-year-intervals | None |
II (transient coronary artery ectasia) | None beyond first 6-8 weeks | No restrictions beyond first 6-8 weeks | Counseling at 3-to-5-year intervals | None |
III (one small medium coronary artery aneurysm) | Low-dose aspirin at least until aneurysm regression is documented | For patients < 11 years: no restrictions;for patients of 11-20 years: physical activity must be guided by stress test and myocardial perfusion scan; discouraged contact or high-impact sports | Annual echocardiogram + ECG; biannual stress test and myocardial perfusion scan | Angiography, if non invasive tests suggest ischemia |
IV (≥1 large or giant coronary artery aneurysm or multiple aneurysms without obstruction) | Long term antiplatelet therapy and warfarin or low molecular weight heparin | Contact or high-impact sports should be avoided because of risk of bleeding; other physical activity recommendations must be guided by stress test and myocardial perfusion scan | Biannual echocardiogram + ECG; annual stress test and myocardial perfusion scan | Angiography at 6-12 months after the disease |
V (coronary artery obstruction) | Long term low-dose aspirin, warfarin or low molecular weight heparin if giant aneurysms persist | Contact or high-impact sports should be avoided because of risk of bleeding; other physical activity recommendations must be guided by stress test and myocardial perfusion scan | Biannual echocardiogram + ECG; annual stress test and myocardial perfusion scan | Angiography is recommended to address the best personalized therapeutic option |