Key result
Kawasaki disease sequelae appear in ~5% of young adults undergoing angiography for suspected ischemia.
Why the study?
Persistent coronary artery aneurysms from Kawasaki disease may remain silent until myocardial ischemia occurs later in life, but their prevalence among young adults undergoing coronary angiography for suspected ischemia is unknown.
Observational (n=261)
Blinded to medical history
Yes
Coronary sequelae of Kawasaki disease are present in approximately 5% of young adults under 40 undergoing coronary angiography for suspected myocardial ischemia, highlighting a subset of patients requiring distinct management strategies.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We have previously shown that ≈5% of young adults undergoing coronary angiography for suspected cardiac ischemia have coronary artery aneurysms consistent with a history of Kawasaki disease.”
“Daniels et al. showed that 5% of young adults with acute coronary syndrome might have antecedent Kawasaki disease in a cohort with Kawasaki disease incidence rates ranging from about 9 to 20 per 100,000 children under 5 years of age.”
Supports Kawasaki disease inquiry in young adults with aneurysms; leaves open whether recognition alters management or outcomes.
BACKGROUND: Up to 25% of patients with untreated Kawasaki disease (KD) and 5% of those treated with intravenous immunoglobulin will develop coronary artery aneurysms. Persistent aneurysms may remain silent until later in life when myocardial ischemia can occur. We sought to determine the prevalence of coronary artery aneurysms suggesting a history of KD among young adults undergoing coronary angiography for evaluation of possible myocardial ischemia. METHODS AND RESULTS: We reviewed the medical histories and coronary angiograms of all adults <40 years of age who underwent coronary angiography for evaluation of suspected myocardial ischemia at 4 San Diego hospitals from 2005 to 2009 (n=261). History of KD-compatible illness and cardiac risk factors were obtained by medical record review. Angiograms were independently reviewed for the presence, size, and location of aneurysms and coronary artery disease by 2 cardiologists blinded to the history. Patients were evaluated for number of risk factors, angiographic appearance of their coronary arteries, and known history of KD. Of the 261 young adults who underwent angiography, 16 had coronary aneurysms. After all clinical criteria were assessed, 5.0% had aneurysms definitely (n=4) or presumed (n=9) secondary to KD as the cause of their coronary disease. CONCLUSIONS: Coronary sequelae of KD are present in 5% of young adults evaluated by angiography for myocardial ischemia. Cardiologists should be aware of this special subset of patients who may benefit from medical and invasive management strategies that differ from the strategies used to treat atherosclerotic coronary artery disease.
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Daniels et al. (2012) conducted an observational in Suspected myocardial ischemia (n=261). Antecedent Kawasaki disease vs. No antecedent Kawasaki disease was evaluated on Prevalence of coronary artery aneurysms definitely or presumed secondary to Kawasaki disease. Coronary sequelae of Kawasaki disease were identified in 5.0% of young adults under 40 years of age undergoing coronary angiography for suspected myocardial ischemia.
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