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Acute coronary syndrome in adult patients with coronary artery lesions caused by Kawasaki disease: review of case reports

Published online by Cambridge University Press:  12 November 2010

Etsuko Tsuda ,
Tadaaki Abe  and
Wataru Tamaki
Etsuko Tsuda*
Affiliation:
Department of Pediatrics, National Cardiovascular Center, Osaka, Japan
Tadaaki Abe
Affiliation:
Department of Pediatrics, National Cardiovascular Center, Osaka, Japan
Wataru Tamaki
Affiliation:
Department of Pediatrics, National Cardiovascular Center, Osaka, Japan
*
Correspondence to: E. Tsuda, MD, Department of Pediatrics, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita-shi, Osaka, 565-8565, Japan. Tel: 81 6 6833 5012; Fax: 81 66872 7486; E-mail: etsuda@hsp.ncvc.go.jp
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Abstract

Information about acute coronary syndrome caused by Kawasaki disease-related coronary artery lesions in adults is sketchy. We reviewed the clinical features of 50 adult patients who had an acute coronary syndrome caused by coronary artery lesions due to Kawasaki disease or probable Kawasaki disease from 1980 to 2008. Of the 50 patients, 43 (90%) were male and seven were female (10%). Their ages at the onset of acute coronary syndrome ranged from 18 to 69 years, with a median of 28 years. The culprit lesion in 43 patients was thrombotic occlusion of an aneurysm, and 40 patients had giant aneurysms. In the three patients in whom no aneurysms were seen in coronary angiograms performed at the time of acute myocardial infarction, either giant aneurysms or aneurysms had been visualised in childhood. The initial treatment of acute coronary syndrome was as follows: intracoronary thrombolysis, 11; primary percutaneous coronary intervention, 9; emergency coronary artery bypass grafting, 3; and medication, 26. Elective coronary artery bypass grafting was performed in 15 patients. Three patients (6%) died. Of the 27 patients with additional coronary risk factors, 20 were smokers. Giant aneurysms due to Kawasaki disease continued to cause acute coronary syndrome in adult life with onset at a younger age than typifies that due to atherosclerosis in the general population, especially in male population rather than female population. Even when giant aneurysms regressed after the acute phase, a few patients still developed acute coronary syndrome in adult life. Smoking appears to be the most prominent additional risk factor.

Keywords

Kawasaki diseasegiant aneurysmacute coronary syndromecoronary artery calcificationsmoking
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 1 , February 2011 , pp. 74 - 82
Copyright
Copyright © Cambridge University Press 2010

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