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

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• 作者：A. Dionne ; M. Bakloul ; C. Manlhiot ; B. W. McCrindle ; M. Hosking…
• 关键词：Kawasaki disease ; Coronary artery bypass ; Percutaneous coronary intervention ; Coronary aneurysm
• 刊名：Pediatric Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：38
• 期：1
• 页码：36-43
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Cardiology; Cardiac Surgery; Vascular Surgery;
• 出版者：Springer US
• ISSN：1432-1971
• 卷排序：38

文摘

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.