Acute Anterior STEMI in a 21-Year-Old Male with Modifiable Lifestyle Risk Factors

A Case Report

Abstract

Background:
Acute myocardial infarction (MI) in very young adults is rare but associated with significant morbidity
and long-term risk.
Methods:
A 21-year-old obese male (BMI 35.2 kg/m2) with smoking history and family history of coronary artery
disease presented with acute anterior ST-elevation myocardial infarction (STEMI). Coronary angiography
revealed single-vessel disease with complete occlusion of the proximal left anterior descending (LAD)
artery. Primary percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation
restored TIMI 3 flow. Post-procedure, the patient developed right bundle branch block but remained
hemodynamically stable. High- sensitivity troponin I peaked at 242,850.6 pg/mL. He was discharged
on optimized guideline- directed medical therapy (GDMT). On follow-up, he remained stable, with
adjustment of medications and emphasis on aggressive secondary prevention.
Discussion:
This case illustrates the importance of recognizing acute coronary syndromes in very young adults,
where modifiable risk factors—particularly obesity and smoking—play a critical role. Adherence to
ESC/ACC guideline-based reperfusion and preventive strategies is essential to optimize outcomes.