LONG-TERM OUTCOME OF MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH KAWASAKI CORONARY-ARTERY DISEASE - A MULTICENTER COOPERATIVE STUDY

The long-term outcome of myocardial revascularization by coronary arte ry bypass grafting in patients with severe coronary obstruction caused by Kawasaki disease is largely unknown. A multicenter follow-up study was performed in 1991. A total of 168 patients with Kawasaki disease (127 male [75.6%] and 41 female patients [24.4%]) who had undergone co ronary bypass grafting were enrolled. Obstructive coronary artery dise ase affected the left main trunk in 11.8%, the right coronary artery i n 77.6%, the left anterior descending in 87.6%, and the left circumfle x in 25.9%. Old myocardial infarction was noted in 46.0% of the patien ts. Fifty-four patients (32%, 12.4 +/- 9.8 years) underwent bypass gra fting with saphenous vein grafts alone. The remaining 114 patients (68 %, 9.8 +/- 7.1 years) received at least one internal thoracic artery g raft to the left anterior descending coronary artery. Gastroepiploic a rtery grafts were used in 12 patients. There were no significant diffe rences between the saphenous vein and internal thoracic artery groups in the mean age at operation (12.4 versus 9.8 years), female ratio (22 % versus 25%), the number of patients over 20 years of age (9.3% versu s 9.6%), previous history of infarction (51.9% versus 41.2%), impaired left ventricular function (ejection fraction < 0.5) (13.0 versus 11.4 %), left main trunk disease (11.1% versus 10.5%), the number of vessel s involved (2.2 +/- 0.8 versus 2.0 +/- 0.6 per patient), or the mean n umber of grafts used (1.7 +/- 0.7 versus 1.7 +/- 0.7 per patient). The operative death rate was also the same in the two groups (1.9% versus 0%), but the late cardiac death rate was significantly higher in the saphenous vein graft group (13.0%) than in the internal thoracic arter y group (0.9%) (p < 0.003). Actuarial analysis showed a significantly higher survival in the internal thoracic artery group (98.7% +/- 1.2% versus 81.6% +/- 7.0%, p < 0.05) at 90 months after the operation. Lat e death was strongly related to the absence of an internal thoracic ar tery graft (p < 0.003) and to the age at the time of operation (p < 0. 05). The actuarial patency rate was significantly higher for arterial grafts (77.1% +/- 1.1%, n = 151) than for vein grafts (46.2% +/- 6.3%, n = 126) 85 months after the operation (p < 0.003). Arterial grafts w ere used for the non-left anterior descending coronary arteries in onl y 41 of 155 grafts (26.5%); in contrast, vein grafts were used in 85 o f 133 grafts (63.9%) (p < 0.005 to 0.001). However, the actuarial pate ncy rate was significantly higher for arterial grafts (81.4% +/- 8.2%, n = 39) than for vein grafts (37.5% +/- 8.0%, n = 81) to the left cir cumflex and right coronary arteries. The difference in patency was eve n greater in children younger than 7 years old at operation (p < 0.005 ). In conclusion, internal thoracic artery grafts showed significantly better long-term patency than saphenous vein grafts in patients with Kawasaki disease, and the use of internal thoracic artery grafts reduc ed the likelihood of late cardiac death.