LONG-TERM OUTCOME OF CORONARY ABNORMALITIES IN PATIENTS AFTER KAWASAKI-DISEASE

From January 1973 through December 1992, a total of 302 patients (183 males, 119 females) with Kawasaki disease (KD) underwent coronary angi ography. The age at onset of KD ranged from 2 months to 12.3 years (me dian 1.4 years). The age at the first angiographic evaluation ranged f rom 6 months to 17 years (median 3.5 years). Most of the patients (85% ) had suffered from KD before 1985 and thus were treated without benef it of gamma-globulin. Follow-up varied from 6 months to 25.8 years (me dian 13.6 years). Coronary abnormalities were confirmed in 71 (23.5%) of 302 patients; the left coronary artery (LCA) alone was involved in 36 cases, the right coronary artery (RCA) alone in 10 cases: and both arteries in 25 cases. Serial angiographic evaluation of the 42 cases r evealed different attitudes in the progress of coronary abnormalities. All large aneurysms showed a tendency to regress, although some progr essed to stenotic lesions. Moderate aneurysms stayed unchanged, regres sed, or progressed to stenosis or obstruction. Small aneurysm never be came stenotic and frequently regressed to normal internal diameter. An eurysms of the RCA tended to regress relatively early during the follo w-up period, whereas those of the LCA gradually progressed to stenotic lesions. In 7 of 35 patients with RCA lesions, aneurysms progressed t o complete obstruction and subsequent recanalization within 0.5 to 7.7 years (median 3.6 years) after the onset of KD. Most of the patients with coronary artery sequelae after KD remain asymptomatic. Serial ang iographic observation is indicated for those patients who develop larg e coronary aneurysms during the acute phase of KD. The standard 12-lea d electrocardiogram, chest roentgenogram, and exercise stress test are less sensitive for detecting and evaluating patients with coronary se quelae. For the screening of myocardial ischemia after KD, stress thal lium 201 scintigraphy with dipyridamole infusion is recommended.