Coronary artery aneurysms are well-described in Kawasaki disease and the Multisystem Inflammatory Syndrome in Children and are graded using Z scores. Three Z score systems (Boston, Montreal, and DC) are widely used in North America. The recent Pediatric Heart Network Z score system is derived from the largest diverse sample to-date. The impact of Z score system on the rate of coronary dilation and management was assessed in a large real-world dataset.

Using a combined dataset of patients with acute Kawasaki disease from the Children’s Hospital at Montefiore and the National Heart, Lung, and Blood Institute Kawasaki Disease Study, coronary Z scores and the rate of coronary lesions (Z ≥ 2.0) and aneurysms (Z ≥ 2.5) were determined using four Z score systems. Agreement among Z scores and the effect on Kawasaki management were assessed.

Of 333 patients analysed, 136 were from Montefiore and 197 from the Kawasaki Disease Study. Age, sex, body surface area, and rate of coronary lesions did not differ between the samples. Among the four Z score systems, the rate of acute coronary lesions varied from 24 to 55%. The mean left anterior descending Z scores from Pediatric Heart Network and Boston had a large uniform discrepancy of 1.3. Differences in Z scores among the four systems may change anticoagulation management in up to 22% of a Kawasaki population.

Choice of Z score system alone may impact Kawasaki disease diagnosis and management. Further research is necessary to determine the ideal coronary Z score system.

冠状动脉瘤在川崎病和儿童多系统炎症综合征中得到了很好的描述，并使用 Z 评分进行分级。三种 Z 评分系统（波士顿、蒙特利尔和华盛顿特区）在北美广泛使用。最近的儿科心脏网络 Z 评分系统源自迄今为止最大的多样化样本。Z 评分系统对冠状动脉扩张和管理率的影响在一个大型真实世界数据集中进行了评估。

使用来自 Montefiore 儿童医院和国家心肺血液研究所川崎病研究的急性川崎病患者的组合数据集，冠状动脉 Z 评分和冠状动脉病变 (Z ≥ 2.0) 和动脉瘤 (Z ≥ 2.5) 的发生率) 是使用四个 Z 评分系统确定的。评估了 Z 分数之间的一致性以及对川崎管理的影响。

在分析的 333 名患者中，136 名来自 Montefiore，197 名来自川崎病研究。样本之间的年龄、性别、体表面积和冠状动脉病变率没有差异。在四个 Z 评分系统中，急性冠状动脉病变的发生率从 24% 到 55% 不等。来自儿科心脏网络和波士顿的平均左前降 Z 分数具有 1.3 的大统一差异。四个系统之间 Z 分数的差异可能会改变多达 22% 的川崎人群的抗凝管理。

单独选择 Z 评分系统可能会影响川崎病的诊断和管理。需要进一步的研究来确定理想的冠状动脉 Z 评分系统。