Abstract O.69: Coronary Vessel Wall Imaging By Using Multi-detector Computed Tomography And Outcomes In Patients Long After Kawasaki Disease: Potential For Risk Stratification

Abstract

Background: In acute coronary syndrome (ACS) in adults after Kawasaki disease (KD), acute thrombosis occurs in culprit lesions with calcified intima even in the absence of giant aneurysms (AN) or severe stenosis. Recently, multi-detector computed tomography (MDCT), a non-invasive modality, was shown to have good diagnostic accuracy of detecting IVUS-defined intimal thickening and calcification. We investigated whether MDCT-derived vessel wall lesions are associated with coronary artery lesions (CAL) and outcomes in patients long after KD. Methods: MDCT was performed and analyzed (Vitrea fX, vs2.0, VITAL) in patients ≥10 years after KD, in which CAL were determined by ultrasound (US) during acute KD and serial CAG (if CAL was detected by US). Any discernible structure under the luminal surface with the CT density with or without areas ≥ 130 Hounsfield units, was defined as a calcified or noncalcified intima. Results: A total of 42 patients (median age 19.7 yo, male 64%, median interval after KD 17.5 y) were recruited and followed-up for 4.0 years (median) (range 0.1-5.5): 23 (55%) patients have any CAL in any segments, including regressed AN in 42 segments, persistent AN in 27 segments, localized stenosis (LS) in 7 segments; normal coronary artery from the onset was found in 225 segments in total patients. MDCT findings revealed no intimal lesions in 271 segments, 6 non-calcified intima, and 24 calcified intima; Mean (range) value of Agatston calcium score was 140 (0-2247) with zero value in 29 (69%). Normal segments from the onset exhibited no intimal lesions (225/225, 100%); regressed AN exhibited no intima (35/42, 83%), non-calcified intima (2/42, 5%), and calcified intima (5/42, 12%); persistent AN exhibited no intima (11/27, 41%), noncalcified intima (4/27, 15%), and calcified intima (12/27, 44%); all the LSs exhibited calcified intima (7/7, 100%). In the follow-up after MDCT, a 23 year-old patient (calcium score 17) had ACS at the culprit lesion with LS <50% and calcified intima; another 16 year-old patient (calcium score 545) had asymptomatic myocardial infarction at the culprit lesion with persistent aneurysm and calcified intima. Conclusions: Coronary vessel wall imaging by using MDCT may have a potential role for risk stratification of adults after KD.