Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention after Kawasaki Disease: The Pediatric Canadian Series.
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.
Division of Pediatric Cardiology (6 - Bloc 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
A
A
Dionne
Division of Pediatric Cardiology (6 - Bloc 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
M
M
Bakloul
Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada.
C
C
Manlhiot
Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada.
B W
BW
McCrindle
Division of Pediatric Cardiology, BC Children's Hospital, Vancouver, BC, Canada.
M
M
Hosking
Division of Pediatric Cardiology, CHUQ, Quebec, QC, Canada.
C
C
Houde
Division of Pediatric Cardiology, Health Science Center, Winnipeg, MB, Canada.
D
D
Pepelassis
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.
N
http://orcid.org/0000-0001-7715-3169
N
Dahdah
D000293:Adolescent; D000368:Aged; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000209:etiology / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
Coronary aneurysm; Coronary artery bypass; Kawasaki disease; Percutaneous coronary intervention
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