Myocardial Infarction in Kawasaki Disease

To evaluate the clinical features, diagnostic methods, treatment courses, and outcomes of myocardial infarction (MI) among patients with Kawasaki disease (KD).

This retrospective, single-center study reviewed patients with a history of KD who experienced MI from 1984 to 2023. Data collection included demographics, clinical presentation, imaging findings, interventions, and outcomes.

Among 22 patients, 86% were male, with a median KD onset of 14 months (range: 3 months-15 years). MI was diagnosed at the time of the event in 7 patients, through surveillance magnetic resonance imaging in 8 asymptomatic cases, and by other diagnostic tests in 4. Nearly half (48%) of the MIs occurred within 3 months of acute KD, and 81% within 2 years. All patients had at least one large or giant coronary artery aneurysm, most commonly in the proximal left anterior descending artery. Seven patients underwent coronary artery bypass grafting, one had percutaneous coronary intervention, and one was listed for heart transplantation. Two patients died from MI-related complications in the 1980s, and 23% had left ventricular dysfunction on follow-up.

A high prevalence of missed MI diagnoses and adverse outcomes highlight the need for improved early detection and management. Although MI occurred only in patients with giant aneurysms, additional risk factors remain unclear. Future studies exploring computational modeling and genetic predispositions may help personalize antithrombotic regimens and optimize care for high-risk patients.