Coronary artery aneurysms that occur in 25% of untreated Kawasaki disease (KD) patients may remain clinically silent for decades and then thrombose resulting in myocardial infarction. Although KD is now the most common cause of acquired heart disease in children in Asia, the United States, and Western Europe, the incidence of KD in Egypt is unknown. We tested the hypothesis that young adults in Egypt presenting with acute myocardial ischemia may have coronary artery lesions due Kawasaki disease (KD) in childhood. We reviewed a total of 580 angiograms of patients ≤ 40 years of age presenting with symptoms of myocardial ischemia. Coronary artery aneurysms were noted in 46 patients (7.9 %) of whom nine presented with myocardial infarction. The likelihood of antecedent KD as the cause of the aneurysms was classified as definite (n=10), probable (n=29), or equivocal (n=7). Compared to the definite and probable groups, the equivocal group had more traditional cardiovascular risk factors, smaller sized aneurysms, and fewer coronary arteries affected. In conclusion, in a major metropolitan center in Egypt, 6.7% of adults age 40 years or younger undergoing angiography for evaluation of possible myocardial ischemia had lesions consistent with antecedent KD. Because of the unique therapeutic challenges associated with these lesions, adult cardiologists should be aware that coronary artery aneurysms in young adults may be due to missed KD in childhood.

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ResultsThe metabolic risk score was determined; patients with a significant metabolic score of at least 3 risk score constituted 66.4% of the total cohort (n = 81 patients).Patients were subjected to coronary angiography. Totally occluded vessels were found in 33.3% of metabolic syndrome patients and in 26.8% of non metabolic syndrome patients (P < 0.05). The SYNTAX score was used to assess the severity of CAD; it was found to be statistically significantly higher in patients with metabolic syndrome than those without (P = 0.001). ConclusionPatients with metabolic syndrome have more severe CADs. Preventive measures against metabolic syndrome and its components are very important and could help avoid the large economic burden of secondary prevention.

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