<p>Patients characteristics.</p>

Background Children with a history of Kawasaki disease (KD) and severe coronary involvement are at risk for acute coronary syndrome later in adulthood even in the absence of severe luminal lesions. We therefore investigated whether the coronary vessel walls in such adults are accompanied by potential substrates for acute coronary syndrome using optical coherence tomography (OCT), a high-resolution imaging modality. Methods OCT was performed in patients who were followed up by serial coronary angiogram (CAG) and cardiac multi-detector computed tomography (MDCT) for ≥ 15 years after the diagnosis of acute KD with coronary artery aneurysms (≥ 6 mm in diameter). Results Eleven patients (6 males, 55%) with median age 25.3 years (IQR: 22.7–30.3) and median interval 22.6 years (19.9–25.8) after acute KD were recruited. We investigated 51 coronary segments, comprising 43 coronary artery lesions (CALs) (19 regressed aneurysms, 37.2%; 16 persistent aneurysms, 31.4%; and 8 localized stenoses, 15.7%) and 8 normal segments (15.7%). OCT findings revealed fibrocalcific plaque in 20 segments (39.2%), fibroatheroma in 16 (31.4%), superficial signal-rich regions with attenuation in 14 (27.5%), microvessels in 18 (35.3%), luminal thrombi in 13 (25.5%), and ruptured plaque in 4 (7.8%). Qualitatively, all but one normal segment showed no OCT-derived abnormalities, whereas CALs, including regressed aneurysms, exhibited fibrocalcific plaques, fibroatheroma, and microvessels, along with luminal thrombi and ruptured plaques. Quantitatively, CAG-derived advanced lesions (persistent aneurysms and localized stenoses) and MDCT-derived calcified plaques were associated with OCT-detected vessel wall abnormalities. Conclusions The present study showed that CALs in adults long after acute KD with severe coronary involvement are associated with OCT-derived vessel wall abnormalities, which are correlated with luminal lesions and MDCT-detected calcified plaques. Although these results do not demonstrate causality and may not be generalizable to milder cases, they warrant further studies to optimize screening and monitoring of adult KD-related coronary sequelae.# 研究背景 曾罹患川崎病（Kawasaki disease, KD）且存在严重冠状动脉受累的儿童，即便未出现严重管腔病变，在成年后仍有发生急性冠状动脉综合征的风险。本研究借助高分辨率成像技术光学相干断层成像（optical coherence tomography, OCT），旨在探究此类成年患者的冠状动脉血管壁是否存在急性冠状动脉综合征的潜在发病底物。 # 研究方法 本研究纳入在确诊急性KD合并直径≥6mm冠状动脉瘤后，接受为期≥15年的系列冠状动脉造影（coronary angiogram, CAG）与心脏多排计算机断层扫描（multi-detector computed tomography, MDCT）随访的患者，对其实施OCT检查。 # 研究结果 本研究共纳入11例患者（男性6例，占比55%），患者中位年龄为25.3岁（四分位间距IQR：22.7~30.3岁），从急性KD确诊至入组的中位间隔时长为22.6年（19.9~25.8年）。本次研究共评估51个冠状动脉节段，其中43个为冠状动脉病变（coronary artery lesions, CALs），包括19个消退性动脉瘤（占比37.2%）、16个持续性动脉瘤（占比31.4%）以及8个局限性狭窄（占比15.7%），剩余8个为正常节段（占比15.7%）。OCT检查结果显示，20个节段存在纤维钙化斑块（占比39.2%），16个节段存在纤维粥样斑块（占比31.4%），14个节段存在浅表信号增高伴衰减区域（占比27.5%），18个节段可见微血管（占比35.3%），13个节段存在腔内血栓（占比25.5%），另有4个节段出现斑块破裂（占比7.8%）。定性分析显示，除1个正常节段外，其余正常节段均未出现OCT检测到的异常；而包括消退性动脉瘤在内的冠状动脉病变节段，则均可见纤维钙化斑块、纤维粥样斑块、微血管，同时伴随腔内血栓与斑块破裂。定量分析显示，CAG检测到的进展性病变（持续性动脉瘤与局限性狭窄）以及MDCT检测到的钙化斑块，均与OCT检出的血管壁异常存在相关性。 # 研究结论 本研究表明，在严重冠状动脉受累的急性KD发病多年后的成年患者中，其冠状动脉病变（CALs）与OCT检测到的血管壁异常存在相关性，且此类异常与管腔病变及MDCT检出的钙化斑块存在关联。尽管本研究结果未证实因果关系，且结论可能无法推广至病情较轻的KD患者，但仍需开展进一步研究以优化成人KD相关冠状动脉后遗症的筛查与监测方案。