ACS in a Young Adult without Conventional Cardiovascular Risk Factors

Abstract

Acute ST-elevation myocardial infarction (STEMI) is uncommon in young adults without documented conventional cardiovascular risk factors and may prompt evaluation for additional metabolic, inflammatory, haematological, and genetic abnormalities. This case report describes a 26-year-old man who presented with chest discomfort and anterior-lead ST-segment elevation. Echocardiography showed severe left ventricular systolic dysfunction, with an ejection fraction of approximately 25–30%. Coronary angiography demonstrated complete occlusion of the left anterior descending artery. Primary percutaneous coronary intervention with drug-eluting stent placement restored Thrombolysis in Myocardial Infarction grade 3 flow. Laboratory evaluation showed low-density lipoprotein cholesterol of 206 mg/dL, serum homocysteine of 19.95 µmol/L, vitamin B12 of 170 pg/mL, and markedly elevated high-sensitivity C-reactive protein concentrations of 140.4–150.6 mg/L. Severe vitamin D deficiency and other inflammatory and biochemical abnormalities were also documented. Extended testing showed normal protein C, free protein S, antithrombin III activity, lipoprotein(a), and ceruloplasmin results, while Factor V Leiden testing was negative. The patient received dual antiplatelet therapy, lipid-lowering treatment, supportive cardiac therapy, and vitamin supplementation. He remained haemodynamically stable, was discharged after 7 days, and was clinically stable at the 1-week follow-up, when low-density lipoprotein cholesterol had decreased to below 100 mg/dL. The case supports comprehensive evaluation of potentially modifiable abnormalities in young adults with premature myocardial infarction while recognising that their individual causal contributions cannot be established from a single case.