Abstract 17770: Limited Efficacy of Rotational Atherectomy to Calcified Coronary Artery Lesion in Patients with Kawasaki Disease; Relatively High Rate of Restenosis and Adverse Cardiac Events
Background: Kawasaki disease(KD) has become the most prevalent acquired cardiac disease in children in developed countries. Although recent studies have demonstrated excellent long-term outcomes of surgical revascularization, the prognostic impact of percutaneous coronary intervention(PCI) using rotational atherectomy(RA) remains unknown.
Methods: Between 1997 and 2010, 14 patients (age; 16±8 years, male; 93%) underwent PCI with RA to the calcified lesions in native coronary arteries due to KD. Six-month follow-up angiography was performed in all patients. We compared clinical and procedural features of patients with (R+) and without restenosis (developing >50% stenosis) (R-) and studied long-term prognosis.
Results: Of 14 patients with 61±12% of left ventricular ejection fraction, 8 patients(57%) had triple vessel disease, and 6 patients(43%) had prior coronary artery bypass grafting(CABG). Any patients did not undergo stent implantation. In 6-month follow-up coronary angiography, 7 patients(50%) had restenosis. Patients with restenosis were younger(R+;12±9 years vs. R-;20±6 years, P<0.05) and had more frequent prevalence of prior CABG(R+;71% vs. R-;14%, P<0.05) and multi-vessel disease(R+;86% vs. R-;29%, P<0.05) than patients without restenosis. Although burr size was significantly smaller in patients with restenosis than those without it(R+;1.90±0.17mm vs. R-;2.10±0.15mm; P<0.05), burr/artery ratio was similar(R+;0.67±0.22 vs. R-;0.63±0.17) . In the median of 5-year follow-up period, the rate of adverse cardiac event was 14%; one patient(R-) died and one patient(R+) underwent repeat angioplasty to the target vessel.
Conclusion: In the present study of 10 to 20-year-old KD patients, restenosis rate of PCI using RA to calcified coronary lesions is relatively high, especially in those with multi-vessel disease. Because the prognostic impact of RA seems to be limited, CABG should be considered as the first choice therapy.
- © 2012 by American Heart Association, Inc.