Early Onset Atherothrombosis: Sudden Cardiac Arrest Complicating Anterior STEMI in a 25-year-old Patient with Elevated Lipoprotein A: A Case Report

Abstract

Background: Lipoprotein A is a genetically determined low-density lipoprotein like particle bound covalently to apolipoprotein. It is increasingly recognized as a highly atherogenic and prothrombotic molecule, contributing to the development and progression of atherosclerotic cardiovascular disease through its pro-inflammatory and pro-oxidative properties, as well as its impairment of fibrinolysis. Randomized studies demonstrate that it is a causal risk factor for atherosclerotic cardiovascular diseases and also it is associated with greater thrombus burden in younger patients with STEMI. Case Presentation: We report the case of a 25-year-old man with no cardiovascular risk factors except family history of coronary artery disease on the maternal side, who was brought to the emergency department after experiencing acute chest pain during a Padel session. Soon after admission he developed sudden cardiac arrest due to ventricular fibrillation successfully resuscitated. EKG post- resuscitation showed anterior ST-segment elevation. Emergent coronary angiography revealed a thrombotic occlusion of the bifurcation LAD II -diagonal treated initially with tirofiban, then etiological work-up identified significantly elevated lipoprotein A levels suggesting possible genetic predisposition to premature coronary thrombosis. Conclusion: Lipoprotein A is a significant yet often under-recognized risk factor for premature coronary artery disease, especially in patients without conventional cardiovascular risk factors. Its measurement should be considered in the diagnostic evaluation of early-onset coronary events.