Rationale: Kawasaki disease (KD) is an acute, self-limiting vasculitis that primarily affects infants and young children, and remains the leading cause of acquired heart disease in the pediatric population. With advancing disease course, adult survivors face a substantially elevated risk of developing secondary coronary artery abnormalities. When acute myocardial infarction (AMI) occurs in this population, outcomes are frequently poor due to the high prevalence of life-threatening complications, including malignant ventricular arrhythmias and cardiogenic shock. Patient concerns: Two young adult patients, aged approximately 30 years, presented with AMI complicated by cardiogenic shock, in the absence of conventional cardiovascular risk factors. Diagnoses: Coronary angiography demonstrated coronary artery aneurysms and multivessel coronary disease in both individuals. Given the lack of traditional cardiovascular risk factors, the AMI events were deemed secondary to long-standing coronary sequelae of antecedent KD. Interventions: Both patients were supported with venoarterial extracorporeal membrane oxygenation. This mechanical circulatory support successfully restored cardiac function and achieved hemodynamic stabilization during the acute critical phase of AMI and cardiogenic shock. Outcomes: Following venoarterial extracorporeal membrane oxygenation support, both patients achieved clinical recovery and were discharged home. However, during subsequent long-term follow-up, both individuals developed recurrent episodes of acute heart failure. Lessons: In patients with acute coronary syndrome attributable to KD-related coronary artery disease, prompt institution of mechanical circulatory support is critical when clinically indicated. This case further underscores that, even with successful acute-phase management, longitudinal follow-up and rigorous cardiac surveillance remain essential for early detection and prevention of progressive heart failure in this high-risk population.
Chen et al. (2026) studied this question.