Risk of Recurrent Arterial XXXX in Childhood: A Prospective International Study.

@entity1 @entity4065 @entity64 @entity1779 @entity4066 @entity385
BACKGROUND AND PURPOSE: Published cohorts of @entity1 with @entity385 ( @entity385 ) in the 1990s to early 2000s reported 5-year cumulative recurrence rates approaching 20%. Since then, utilization of antithrombotic agents for secondary @entity64 prevention in @entity1 has increased. We sought to determine rates and predictors of recurrent @entity64 in the current era. METHODS: The Vascular Effects of Infection in @entity64 (VIPS) study enrolled 355 @entity1 with @entity385 at 37 international centers from 2009 to 2014 and followed them prospectively for recurrent @entity64 . Index and recurrent @entity64 underwent central review and confirmation, as well as central classification of causes of @entity64 , including arteriopathies. Other predictors were measured via parental interview or chart review. RESULTS: Of the 355 @entity1 , 354 survived their acute index @entity64 , and 308 (87%) were treated with an antithrombotic medication. During a median follow-up of 2.0 years (interquartile range, 1.0-3.0), 40 @entity1 had a recurrent @entity385 , and none had a @entity64 . The cumulative @entity64 recurrence rate was 6.8% (95% confidence interval, 4.6%-10%) at 1 month and 12% (8.5%-15%) at 1 year. The sole predictor of recurrence was the presence of an @entity4065 , which increased the risk of recurrence 5-fold when compared with an idiopathic @entity385 (hazard ratio, 5.0; 95% confidence interval, 1.8-14). The 1-year recurrence rate was 32% (95% confidence interval, 18%-51%) for moyamoya, 25% (12%-48%) for transient @entity1779 , and 19% (8.5%-40%) for @entity4066 . CONCLUSIONS: @entity1 with @entity385 , particularly those with @entity4065 , remain at high risk for recurrent @entity385 despite increased utilization of antithrombotic agents. Therapies directed at the arteriopathies themselves are needed.
