142 - MYOCARDIAL INFARCTION IN KAWASAKI DISEASE: INSIGHTS FROM A NORTH AMERICAN CASE SERIES

Background

Myocardial infarction (MI) is a rare but life-threatening complication of KD. This study aimed to characterize the clinical features, treatment course, and outcomes of children with MI secondary to KD.

Methods

We conducted a single-center retrospective descriptive study of patients with a history of KD who suffered an MI from 1984 to 2023. Comprehensive data collection included demographic, clinical, imaging, and interventional variables. Outcomes included death, arrhythmia, heart transplant listing, and coronary artery interventions.

Results

Among 22 patients with MI, 86% were male. Median age at KD onset was 14 months (range 3 months–15 years). Diagnosis of MI was made in 7 at the time of event; 8 by late gadolinium enhancement on surveillance MRI in asymptomatic patients; 4 by other diagnostic tests (combination of echocardiography, nuclear imaging, electrocardiograms, and laboratory markers); and 3 not documented. MI was diagnosed ≤ 3 months of acute KD in 48% of patients, ≤ 1 year in 62%, and ≤ 2 years in 81%. Clinical symptoms of acute MI were recognized in 4 patients in real time and 3 retrospectively.  All patients had ≥ 1 persistent large/giant coronary artery aneurysm, and most had bilateral aneurysms (Table). The proximal left anterior descending artery was the most commonly involved vessel. Seven patients underwent coronary artery bypass surgery, one had percutaneous coronary intervention, and one was listed for cardiac transplantation. Two patients died from MI-related complications in the 1980s, and 23% had left ventricular dysfunction on follow-up. 

Conclusions

A high rate of missed diagnosis and adverse outcomes of MI highlights the need for timely and improved recognition and management strategies to optimize outcomes. Future research may explore computational modeling and genetic factors to personalize antithrombotic regimens for patients with giant aneurysms.