Patient handout

STEMI from prior Kawasaki disease coronary aneurysm / stenosis

PRODUCTION

1. Your condition

This handout is for stemi from prior kawasaki disease coronary aneurysm / stenosis. Your care team identified this based on: young adult (20-40s) with documented childhood kawasaki disease history presenting with chest pain.

Other reasons your team may use this plan: st elevation on ecg in patient with known persistent coronary aneurysm from kd — emergent cath; incidental giant coronary aneurysm finding on cardiac imaging in adult presenting with acs — kd aneurysm presumed.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed load → 81 mg daily lifelong	PO	daily indefinitely	AHA Kawasaki 2024 (PMID 38683866) — ASA lifelong if persistent aneurysm; AHA 2025 ACS Class I for STEMI
ticagrelor	180 mg load → 90 mg BID	PO	BID × 12 mo standard DAPT, then reassess	PLATO PMID 19717846; standard DAPT post-PCI; duration may extend beyond 12 mo if persistent aneurysm thrombus
unfractionated heparin	70-100 U/kg IV bolus + activated infusion	IV	bolus + infusion at PCI; transition to long-term AC if giant aneurysm	AHA 2025 Class I for PCI; AHA Kawasaki 2024 — AC indicated for giant aneurysm thrombus
warfarin	5 mg daily; INR target 2-3 indefinitely if persistent giant aneurysm with thrombus	PO	daily indefinitely if giant aneurysm + thrombus	AHA Kawasaki 2024 (PMID 38683866) Class I lifelong AC for giant aneurysm with thrombus; warfarin preferred over DOAC due to limited DOAC RCT data in this population
apixaban	5 mg BID (or 2.5 mg BID per dose-reduction criteria)	PO	BID	AHA Kawasaki 2024 — DOAC alternative if warfarin contraindicated; off-label-but-rational; small case series support use
atorvastatin	40-80 mg daily lifelong	PO	daily	AHA Kawasaki 2024 — statin lifelong post-coronary-event regardless of LDL; PROVE-IT framework + KD-specific endothelial dysfunction rationale
carvedilol	3.125 mg BID titrate	PO	BID	CAPRICORN PMID 11356436 — post-MI BB benefit; carvedilol preferred for HFrEF GDMT
sacubitril-valsartan	24/26 mg BID titrate	PO	BID	PIONEER-HF PMID 30403955; ACC/AHA 2022 HF Class I if HFrEF persists post-MI

Plan: Kawasaki disease coronary aneurysm + STEMI regimen — combines parent acute reperfusion with lifelong aneurysm-thrombosis prevention; triple therapy if persistent giant aneurysm with thrombus

3. When to call your provider

Contact your care team if any of the following happen:

New aneurysm or aneurysm enlargement on CTA → adult congenital cardiology + interventional consultation
EF declining despite the four foundational heart-failure medications → advanced HF / transplant evaluation
Bleeding on triple therapy → reassess regimen

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Coronary angiogram or CTA showing giant aneurysm (≥8 mm or Z-score ≥10) with extensive intra-aneurysmal thrombus + STEMI(life-threatening)
Multivessel coronary involvement with multiple aneurysms where PCI is technically infeasible → CABG required(life-threatening)
EF <35 + non-sustained VT on telemetry post-KD-STEMI → SCD risk in 40-90 d window(life-threatening)
Young adult with KD history presenting acutely without established adult congenital cardiology care; never transitioned from pediatric care

5. Follow-up

Lifetime ASA + statin; long-term AC if persistent giant aneurysm with thrombus; serial coronary CTA (preferred over invasive cath in stable patient); transplant referral if severe LV dysfunction; pregnancy + family planning counseling (for women); transition pediatric → adult congenital cardiology

6. Sources

Guideline: AHA Kawasaki disease 2024 statement + JCS 2020 Kawasaki adult cardiac sequelae + 2025 ACC/AHA ACS Guideline + Kato Circulation 1996 long-term follow-up