Kawasaki disease (KD) is a rare and self-limiting inflammatory disease of medium size blood vessels (mostly of coronary arteries) of unknown etiology. It develops mostly in infants and young children. Its diagnosis is based on typical clinical signs, including: fever, rash, cervical lymphadenopathy, erythema on hands and feet. The inflammatory process may lead to development of aneurysms of coronary arteries and to early atherosclerosis, resulting in acute coronary syndromes in adult patients. We present the case of a 40-years-old male probably post KD in childhood, admitted because of myocardial infarction with ST elevation (STEMI) of the anterior wall, in whom coronarography demonstrated obstruction of LAD and aneurysm of its proximal section. After an unsuccessful angioplasty the patient was qualified for coronary-aortic bypass grafting (CABG) of obstructed LAD, using the MITCAB method. Acute coronary syndromes in patients with history of Kawasaki disease during childhood are described in case reports only, and absence of any clear guidelines makes the analysis of individual cases highly valuable.

Worldwide, cardiovascular incidents are estimated to cause 17.5 million deaths, 80% of which are ischemic strokes or acute coronary syndromes. Cardiovascular disease results in a significant financial burden for healthcare system-namely, in 2009, it was 9% of the gross health service expenditure in the European Union. Therefore, the development of the knowledge about atherosclerosis-initially thought to be solely degenerative disorder but now considered a multifactorial inflammatory state-is essential. Acute coronary syndrome (ACS) is usually a manifestation of severe reduction in coronary blood flow caused by atherosclerotic plaque and thrombus. The pathology of the atherosclerotic plaque is complex. Essentially, it is disease of the arterial intima that, through subsequent stages, results to luminal narrowing. Over the years, various theories regarding the genesis growth and vulnerability of atherosclerotic lesions have been promoted, usually focusing on endothelial injury, smooth muscle cell proliferation, lipid accumulation, and, more recently, inflammatory reactions.