Abstract 11464: Spectrum and Associated Factors for Coronary Artery Involvement in Kawasaki Disease versus Multisystem Inflammatory Syndrome in Children Associated With Covid-19

Abstract

Introduction: Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 share clinical features and are both associated with coronary artery (CA) involvement. Methods: From January 2020 through January 2022, n=2566 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 39 sites in 8 countries were enrolled into the International KD Registry. The study population was confined to 875 MIS-C patients meeting CDC criteria with confirmed or probable COVID-19 infection, and 492 KD patients meeting AHA guideline criteria without COVID-19 infection who had sufficient echo data. CA involvement was defined by maximum Z score in any branch at any timepoint (maxCAZ). Associated factors for each diagnosis were determined with multivariable logistic regression for maxCAZ>2. Results: Median maxCAZ was higher for KD (+1.43) vs MIS-C patients (+1.33; p=0.004). The groups did not differ regarding the incidence of maxCAZ>2 (KD 26% vs MIS-C 24%; p=0.42), although MIS-C patients had less severe Z score categories of involvement (FIGURE). In univariate analyses, higher peak troponin I (p<0.05) and NTproBNP (p=0.06) were associated with maxCAZ>2 for MIS-C but not KD patients. Lower LV ejection fraction was likewise associated with maxCAZ>2 for MIS-C (p=0.009) but not KD patients. For KD patients, independent factors associated with maxCAZ>2 were male sex, age <6 months, greater total days of fever, shock presentation, and higher peak platelet count and CRP (c-statistic 0.69). In contrast, for MIS-C patients the only independent factor associated with maxCAZ>2 was male sex (c-statistic 0.56). Conclusions: Compared to KD patients, MIS-C patients have a similar incidence but lesser severity of CA involvement with few associated factors, male sex being the only one in common. CA involvement was significantly associated with higher cardiac biomarkers and lower LV ejection fraction for MIS-C patients only.