Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9368
Peer-review started: April 13, 2022
First decision: May 12, 2022
Revised: May 24, 2022
Accepted: August 5, 2022
Article in press: August 5, 2022
Published online: September 16, 2022
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.
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.
For KD presenting with ACS, regular follow up and medical therapy may be crucial for improved outcomes.
Core Tip: Kawasaki disease can lead to coronary artery aneurysms. The presence of a coronary artery aneurysm increases the risk of developing acute coronary syndrome. However, we found that proper long-term medical care or regular examination had not been provided to the 19 previously reported patients in this case series. Thus, based on the Z scores, our data highlight the importance of meticulous care by a cardiac specialist.