Abstract 17583: Nationwide Survey of Patients With Giant Aneurysm Caused by Kawasaki Disease in Recent 10 Years: Analysis of Myocardial Infarction and Cardiac Death
Background and Objective: Longterm prognosis of patients with giant aneurysm caused by Kawasaki disease (KD) is not yet well understood. We performed a nationwide survey of patients with giant aneurysm caused by KD in recent 10 years, and analyzed the cases of acute myocardial infarction (AMI) and cardiac death.
Methods: Nationwide epidemiological survey of KD has been conducted every 2 years since 1970 in Japan. We performed questionnaire survey based on 16th - 21th (1999- 2010) nationwide epidemiological data.
Results: We send questioners to 275 facilities asking about 415 patients who were reported to have giant aneurysm (>=8mm), and collected the data of 334 patients (80.5%). We excluded 84 non-giant aneurysm patients and 36 duplicated cases. The final outcome of 214 patients was: 176 patients were being followed, 13 patients were dead, 11 patients dropped out, and there were no answered queries for 14 patients from finally referred hospitals. Description of AMI was observed in 32 out of 202 patients (15.8%). The first AMI attack was mostly reported within a few months from KD onset (medium 5 months (0-85 months)). AMI was occurred one time in 26 patients, and two times in 6 cases. Myocardial ischemia was observed in 80% of AMI patients, and 12 patients were received coronary artery bypass graft, and catheter treatment was conducted in 3 patients. Thirteen patients were dead (medium 1 month (0-23 months) from KD onset). There were 6 cardiac deaths within 1 month from KD onset (5: rupture of aneurysm, 1: AMI). The other cases were dead by AMI except for 2 accident death. Four out of 6 AMI deaths were caused by the first AMI attack. For the remaining 2 cases, the period until fatal second AMI attack from the first one was 1 month and 6 month, respectively. Left anterior descending artery was estimated to be responsible vascularity for all AMI cardiac death.
Conclusion: AMI and cardiac death of the patients who had giant aneurysm occurred mostly in early phase of the onset. When the patients survive the first month of KD onset and overcome the first AMI, patient survival become promising. There was no cardiac death after 24 months from the onset. Acute phase treatment strategy is extremely important for prognosis for KD with giant aneurysm.
- © 2013 by American Heart Association, Inc.