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.
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Copyright (c) 2026 Aamir Sohail, and Syeda Ali
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