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Pediatr Cardiol. 2017 Jan;38(1):36-43. doi: 10.1007/s00246-016-1480-x. Epub 2016 Sep 23.

Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention after Kawasaki Disease: The Pediatric Canadian Series.

Author information

1
Division of Pediatric Cardiology (6 - Bloc 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
2
Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada.
3
Division of Pediatric Cardiology, BC Children's Hospital, Vancouver, BC, Canada.
4
Division of Pediatric Cardiology, CHUQ, Quebec, QC, Canada.
5
Division of Pediatric Cardiology, Health Science Center, Winnipeg, MB, Canada.
6
Division of Pediatric Cardiology (6 - Bloc 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada. nagib.dahdah.hsj@ssss.gouv.qc.ca.

Abstract

Coronary artery (CA) aneurysms are serious complications of Kawasaki disease (KD) responsible for ischemic events. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are reported with limited data on indications and comparative efficacy. Retrospective multicenter comparison of CA intervention following KD is performed in this study. Twenty two cases were available from 5 centers, of whom 11 underwent CABG, 10 PCI and 1 systemic thrombolysis. Age at intervention (8.3 ± 3.9 vs 11.3 ± 4.9 years, p = 0.14) and interval from diagnosis (5.6 ± 4.1 vs 6.5 ± 4.7 years, p = 0.64) were similar between CABG and PCI. Interventions were based on angiography in 15 patients or cardiac event in 7, with no difference between CABG and PCI (p = 0.24). Patients with CABG were more likely to undergo multivessel intervention (73 vs 10 %, p = 0.006). None of the patients needed reintervention after CABG, compared to 6 after PCI and 1 after systemic thrombolysis (p = 0.004). Signs of ischemia on stress testing or MIBI were present in 15 patients before intervention and persisted in 9 patients following last intervention, in a significantly higher proportion after CABG than PCI (80 vs 17 %, p = 0.01). In this series, CABG, which mostly involved multivessel intervention, was superior to PCI. Nevertheless, larger-scale studies may help define patient selection criteria for a beneficial PCI approach.

KEYWORDS:

Coronary aneurysm; Coronary artery bypass; Kawasaki disease; Percutaneous coronary intervention

PMID:
27663723
DOI:
10.1007/s00246-016-1480-x
[Indexed for MEDLINE]

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