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Myocardial Infarction in Kawasaki Disease
Sunil J Ghelani1, Annette L Baker1, Kevin Friedman1
1Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
Objective:
To evaluate the clinical features, diagnostic methods, treatment courses, and outcomes of myocardial infarction (MI) among patients with Kawasaki disease (KD).
Study Design:
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.
Results:
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.
Conclusions:
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.
Insights
Myocardial infarction (MI) in Kawasaki disease (KD) patients often goes undiagnosed, leading to adverse outcomes. Early detection and management are crucial, especially for those with giant coronary artery aneurysms.
Area of Science:
- Cardiology
- Pediatric Rheumatology
- Vascular Medicine
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms are a known complication of KD, increasing the risk of myocardial infarction (MI).
- Understanding the clinical trajectory of MI in KD patients is essential for improving outcomes.
Purpose of the Study:
- To investigate the clinical features, diagnostic approaches, treatment strategies, and patient outcomes for myocardial infarction (MI) in individuals with a history of Kawasaki disease (KD).
Main Methods:
- A retrospective analysis of patients diagnosed with both KD and MI between 1984 and 2023 at a single center.
- Data included patient demographics, KD onset, MI diagnosis methods, timing of MI relative to KD, coronary artery status, interventions, and clinical outcomes.
- Review of medical records, imaging findings (including MRI), and procedural data.
Main Results:
- Twenty-two patients with KD experienced MI, predominantly males (86%), with a median KD onset at 14 months.
- MI was diagnosed during acute illness (32%), via surveillance (36%), or other tests (18%).
- Most MIs occurred within 2 years of KD diagnosis (81%), in patients with large/giant coronary artery aneurysms, primarily in the left anterior descending artery. Interventions included bypass surgery (7 patients) and PCI (1 patient).
Conclusions:
- A significant proportion of MI cases in KD patients were missed, underscoring the need for enhanced early detection and management protocols.
- While giant aneurysms were present in all MI cases, other contributing risk factors require further investigation.
- Future research should focus on computational modeling and genetic factors to personalize antithrombotic therapy and optimize care for high-risk KD patients.
