Abstract 11425: Prevalence of Kawasaki Disease in Young Adults with Suspected Myocardial Ischemia
Background: Up to 25% of patients with untreated Kawasaki Disease (KD) and 5% of those treated will develop coronary artery aneurysms. Missed diagnosis may occur when the clinical signs of KD go unrecognized in childhood. Persistent aneurysms may remain silent until later in life when myocardial ischemia can occur. We sought to determine the prevalence of coronary artery aneurysms suggesting missed KD among young adults undergoing coronary angiography for evaluation of possible myocardial ischemia.
Methods: We reviewed the medical history (hx) and coronary angiograms of all adults under age 40 who underwent coronary angiography for evaluation of suspected myocardial ischemia at 4 San Diego hospitals from 2005-2009. History of KD-compatible illness and cardiac risk factors (RFs) including lipids; hx of hypertension, diabetes, obesity, or smoking; and family hx of early coronary artery disease (CAD) were obtained by medical record review. Angiograms were independently reviewed for the presence, size, and location of both aneurysms and CAD by 2 cardiologists blinded to the hx. Patients were scored based on their number of cardiac RFs, the angiographic appearance of their coronary arteries, and known hx of KD (max score 16). Antecedent KD was coded as unlikely, possible, or highly probable.
Results: Of the 268 young adults who underwent angiography, charts and angiograms were available in 233 (median age 36, 73% men); 16 had coronary aneurysms (Table). After all scoring criteria were assessed, 7 patients had possible and 6 had highly probable KD. Overall, 5.6% of patients had possible or highly probable KD as the etiology of their coronary disease.
Conclusion: Coronary sequelae due to missed KD are responsible for a small but important percentage of young adults who present with myocardial ischemia. Cardiologists should be aware of this special subset of patients who may benefit from systemic anticoagulation and other management strategies that differ from traditional CAD.
- © 2011 by American Heart Association, Inc.