Abstract 11159: Acute Coronary Syndrome in Adults with a History of Kawasaki Disease: A Japanese Nationwide Survey
Background: A risk for acute coronary events in adults with a history of Kawasaki disease (KD) is still speculative.
Methods: We conducted a nationwide questionnaire survey to test the hypothesis that there are a substantial number of acute coronary syndrome (ACS) events in adults with a history of KD in Japan, and these events are characterized by abnormal vessel wall, luminal shape, or conventional risk factors.
Results: The primary response rate in the survey was 46.3%. A total of 67 patients (median age: 35yo, male/ female: 50/17) were recruited. A definitive diagnosis of KD was made in 31 patients during acute illness in childhood, including 15 dropouts of follow-up, while a putative diagnosis was made in 36 from imaging modalities or pathology at events. Coronary events (/66) included unstable angina in 17 cases, ST-elevated myocardial infarction (STEMI) in 34, non-STEMI in 6, and cardiac arrest in 9. The number of risk factors (/65 cases) was 0/5 in 24 cases, 1/5 in 25, 2/5 in 11, and 3/5 in 5. The culprit lesion (/64) was RCA in 32, LMT in 6, LAD in 28, and LCX in 8. Therapeutic approaches toward ACS included thrombolysis in 14/53, balloon angioplasty (POBA) in 22/57, stenting in 18/57, thrombus aspiration in 23/57, and emergency bypass surgery in 10/62. On the prognosis (/67), death ≤ 1 day and 1 month, and survival at 1 month was confirmed in 7, 5, and 55, respectively. The culprit lesion was associated with demonstrable thrombus in 41/56, coronary aneurysm in the vicinity in 49/59 (4-5.9mm in 10, 6-7.9mm in 15, ≥8mm in 24), and IVUS-defined calcification in 12/12. As the lesions presumed to represent % stenosis just before the event, culprit lesions (/12), which were approached without POBA or stenting, exhibited 0%, ≤50%, 51-75%, and 76-99% stenosis in 1, 5, 2, and 4 cases after the treatment, respectively. The former 2 groups (/6) were associated with no aneurysms in 2, 6-7.9 mm of aneurysms in 2, and ≥8 mm of aneurysms in 2.
Conclusions: There are a substantial number of ACS events in young adults with a history of KD but with few conventional risks in Japan. These events were due to acute thrombosis at the culprit lesions, which were characterized by IVUS-defined calcification in the vicinity of various sizes of aneurysms, but were not always associated with significant stenosis.
- © 2011 by American Heart Association, Inc.