ST-segment elevation myocardial infarction in Kawasaki disease: A case report and review of literature

Abstract

BACKGROUND Kawasaki disease (KD) is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm (CAA). CAAs are associated with a high rate of adverse cardiovascular events. CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain. Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram. An aneurysm of the left circumflex (LCX) coronary artery was found with massive thrombi within. A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications. The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7, suggestive of a small aneurysm considering his age, sex, and body surface area. We further present a case series of 19 patients with KD, including the current patient, presenting with acute coronary syndrome (ACS). Notably, none of the cases showed Z scores; only five patients (26%) had been regularly followed up by a physician, and only one patient (5.3%) was being treated with antithrombotic therapy before ACS occurred. CONCLUSION For KD presenting with ACS, regular follow up and medical therapy may be crucial for improved outcomes.

When two Z-scores meet - Analysis of exercise capacity of children and adolescents with Kawasaki disease by a new Z-score model of coronary artery and a new Z-score evaluating peak oxygen consumption

“…Both these studies demonstrated the presence of an abnormal vascular structure even though small CAAs in the acute phase of KD reverted to a normal appearance in the convalescent phase at the previous site of an acute CAA(36, 37). Some reports have described patients with angiographically normal CA after acute KD who later developed cardiovascular disorders in their early adulthood (38,39). Therefore, regular follow-up of KD patients with echocardiography and CPET after the acute stage is crucial.…”

When two Z-scores meet—analysis of exercise capacity of children and adolescents with Kawasaki disease by a new Z-score model of coronary artery and a new Z-score evaluating peak oxygen consumption

“…Both these studies demonstrated the presence of an abnormal vascular structure even though small CAAs in the acute phase of KD reverted to a normal appearance in the convalescent phase at the previous site of an acute CAA [ 36 , 37 ]. Some reports have described patients with angiographically normal CA after acute KD who later developed cardiovascular disorders in their early adulthood [ 38 , 39 ]. Therefore, regular follow-up of KD patients with echocardiography and CPET after the acute stage is crucial.…”