Emergence and Characterization of Acute Coronary Syndrome in Adults After Confirmed or Missed History of Kawasaki Disease in Japan: A Japanese Nationwide Survey

Frontiers in Pediatrics

article

Yoshihide Mitani¹  Mamoru Ayusawa²  Tohru Kobayashi³  Fukiko Ichida⁴  Masaki Matsushima⁵  Masahiro Kamada⁶  Kenji Suda⁷  Hiroyuki Ohashi¹  Hirofumi Sawada¹  Takaaki Komatsu⁸  Kenji Waki⁹  Etsuko Tsuda^1,10  Masanori Shinoda^1,11  Ryusuke Tsunoda^1,12  Hiroyoshi Yokoi^1,13  Kenji Hamaoka^1,14  Hitoshi Kato³  Takashi Higaki^1,15  Masako Fujiwara^1,16  Shunichi Ogawa^1,17  Fumiko Satoh^1,18  Yoshikazu Nakamura^1,19  Kei Takahashi^2,20 

[1] Department of Pediatrics, Mie University Graduate School of Medicine;Department of Pediatrics and Child Health, Nihon University School of Medicine;Division of Clinical Research Planning, Department of Development Strategy and Cardiology, Center for Clinical Research and Development, National Center for Child Health and Development;Department of Pediatrics, Toyama University School of Medicine;Department of Pediatric Cardiology, Chukyo Hospital;Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital;Department of Pediatrics and Child Health, Kurume University;Department of Cardiology, Dokkyo Medical University Koshigaya Hospital;Department of Pediatrics, Kurashiki Central Hospital;Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center;Department of Cardiology, Toyota Kosei Hospital;Department of Cardiology, Japanese Red Cross Kumamoto Hospital;Cardiovascular Center, Fukuoka Sanno Hospital;Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine;Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine;Department of Pediatrics, Jikei University School of Medicine;Department of Pediatrics, Nippon Medical School;Department of Forensic Medicine, Tokai University School of Medicine;Department of Public Health, Jichi Medical University;Department of Pathology, Toho University Medical Center, Ohashi Hospital

关键词: Kawasaki disease;    coronary aneurysm;    acute coronary syndrome;    transition;    long-term issue;   

DOI  :  10.3389/fped.2019.00275

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Acute coronary syndrome (ACS), which is emerging in adults long after confirmed (followed-up or lost-to-follow), or missed Kawasaki disease (KD), is poorly characterized. Methods and Results: A Japanese retrospective nationwide hospital-based questionnaire survey of ACS during 2000–09 was conducted to characterize such patients. Among a total of 67 patients (median age 35, male 76%) recruited, low conventional coronary risks (≤1/6) was noted in 75%, a diagnosis of ST-elevation and myocardial infarction or cardiac arrest in 66%, medication before ACS in 22% (warfarin in 4%), and no prior history of acute myocardial infarction in 94%. One-month mortality was 19%. KD diagnosis was made in 32 during acute illness (Group A), in which 17 were lost to follow, and retrospectively in the other 35 from coronary imaging at ACS (Group B). Group A developed ACS at lower coronary risks (≤2/5 in 87 vs. 65% in group B, p = 0.043) at a younger age (26.5 vs. 40 yo, p < 0.001). In group A, followed-up patients developed ACS under medication before ACS (87 vs. 0% in lost-to-follow patients, p < 0.001) for giant aneurysm in culprit lesions (69 vs. 29%, p = 0.030). One-month mortality was comparable between groups A and B, and between patients followed-up and lost-to-follow in group A. The culprit lesion in group A was characterized by the association of an aneurysm ≥6 mm in acute KD (100%), lack of significant stenosis (61%) or giant aneurysm (50%) in the long-term (median interval 16 y), and the presence of intravascular ultrasound-derived calcification at ACS (86%). Conclusions: The present retrospective nationwide questionnaire survey demonstrated nationwide emergence of initial ACS in young adults at low coronary risks, who are followed-up or lost-to-follow after confirmed KD and initial coronary aneurysms ≥6 mm.

【 授权许可】

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