Journal of Clinical Pediatrics and Neonatal Care

Acute Coronary Syndrome in Young Adult Patients with a History of Kawasaki Disease

Takashi Higaki
Department Of Pediatrics, Ehime University Graduate School Of Medicine, Toon, Ehime, Japan

Published on: 2018-12-25

Abstract

Introduction: Recently there have been several reports of acute coronary syndrome (ACS) in adult patients with a history of Kawasaki disease. However, the actual situations and clinical conditions are unclear. Objective and Methods: We retrospectively analyzed the clinical course and prognosis retrospectively for adult (≥20 years old) patients in Ehime Prefecture who developed ACS and those who were diagnosed with or suspected of having Kawasaki disease sequelae. Results and Discussion: Twelve ACS episodes were observed in nine patients. Five out of nine patients were continuously followed up regularly with anticoagulant therapy since the onset of Kawasaki disease, the remaining four patients who did not followed. They were diagnosed with sequela of Kawasaki disease for the first time by coronary angiography when admitted to ACS. Giant coronary artery aneurysms were recognized in six patients. All follow-up patients who developed ACS had giant coronary artery aneurysm, and AMI occurred based on stenotic lesions in cases without follow-up. As a characteristic finding in one case of thrombotic occlusion, fibrotic-fatty wall thickening by intravascular ultrasound (IVUS) unsuitable for the age were recognized, at coronary artery which had no coronary artery aneurysm and appeared normal. It was concern of early arteriosclerosis progression. Conclusions: The number of the patients with ACS who had sequelae of undiagnosed Kawasaki disease may increase in the future. It is important to establish the system of stratify the risks of ACS in patients with a history of Kawasaki disease.

Keywords

Pediatrics

Copyright: © 2018 Takashi Higak

Abstract

Introduction:

Recently there have been several reports of acute coronary syndrome (ACS) in adult patients with a history of Kawasaki disease. However, the actual situations and clinical conditions are unclear.

Objective and Methods:

We retrospectively analyzed the clinical course and prognosis retrospectively for adult (≥20 years old) patients in Ehime Prefecture who developed ACS and those who were diagnosed with or suspected of having Kawasaki disease sequelae.

Results and Discussion

Twelve ACS episodes were observed in nine patients. Five out of nine patients were continuously followed up regularly with anticoagulant therapy since the onset of Kawasaki disease, the remaining four patients who did not followed. They were diagnosed with sequela of Kawasaki disease for the first time by coronary angiography when admitted to ACS. Giant coronary artery aneurysms were recognized in six patients. All follow-up patients who developed ACS had giant coronary artery aneurysm, and AMI occurred based on stenotic lesions in cases without follow-up. As a characteristic finding in one case of thrombotic occlusion, fibrotic-fatty wall thickening by intravascular ultrasound (IVUS) unsuitable for the age were recognized, at coronary artery which had no coronary artery aneurysm and appeared normal. It was concern of early arteriosclerosis progression.

Conclusions

The number of the patients with ACS who had sequelae of undiagnosed Kawasaki disease may increase in the future. It is important to establish the system of stratify the risks of ACS in patients with a history of Kawasaki disease.