Table 4.

Cardiovascular risk stratification for patients with Kawasaki syndrome

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