Age-Stratified Risk Factors for Coronary Thrombosis in Kawasaki Disease Patients with Medium-to-Large Coronary Artery Aneurysms.

Objective: To identify risk factors for coronary thrombosis in Kawasaki disease (KD) patients with medium-to-large coronary artery aneurysms (CAA) (stratified by age at disease onset). Methods: This retrospective study analyzed 490 consecutive KD patients with medium-to-large CAA treated at Children's Hospital of Chongqing Medical University. Demographic characteristics, initial treatment details, and follow-up echocardiographic data were collected. We divided KD patients into three categories according to age at disease onset: age <12 months, aged 12-47 months, and age >47 months. Multivariable logistic regression models were employed to assess coronary thrombosis risk factors in different age groups. Results: Analysis showed the risk of coronary thrombosis by age after adjustment for confounders. In patients younger than 12 months, multiple coronary artery involvement and the left anterior descending artery (LAD) involvement was associated with coronary thrombosis. In KD patients older than 47 months, large CAA and multiple coronary artery involvement was associated with coronary thrombosis, In KD patients aged 12-47 months, male, intravenous immunoglobulin (IVIG) resistance, delayed IVIG initiation (>10 days post-fever onset), multiple coronary artery involvement and LAD involvement was associated with coronary thrombosis. Conclusion: For KD with medium-to-large CAA, independent risk factors besides multiple coronary artery involvement are stratified by age. These findings underscore the importance of age-specific risk stratification to optimize thromboprophylaxis and long-term management.