Why this case matters
Combined oral contraceptives (COCs) are widely prescribed and generally considered safe, yet they remain associated with rare arterial thrombotic events. This report describes a 28-year-old woman with no conventional cardiovascular risk factors who developed an acute anterior ST-elevation myocardial infarction (STEMI) after 13 years of second-generation COC use. Coronary angiography demonstrated an isolated thrombotic occlusion of the mid-left anterior descending artery without evidence of atherosclerosis, supporting a predominantly thrombotic mechanism.
The case
The patient presented with 11 hours of typical ischemic chest pain. Electrocardiography demonstrated anterior ST-segment elevation, and emergent coronary angiography identified thrombotic LAD occlusion. Balloon angioplasty alone restored normal coronary flow without the need for stent implantation because there was no underlying plaque or residual stenosis. Extensive thrombophilia testing was negative, oral contraceptives were discontinued, and standard secondary prevention therapy was initiated. At 3-month follow-up, CT coronary angiography showed a patent LAD, and left ventricular systolic function improved from 45% to 50–55%.
What we learned
This case reminds clinicians that myocardial infarction can occur in young women taking combined oral contraceptives even when traditional cardiovascular risk factors are absent. It also demonstrates that selected patients with non-atherosclerotic coronary thrombosis may be successfully treated with plain balloon angioplasty without stent implantation, provided angiographic findings support this strategy.
Clinical Take-Home Message
When evaluating acute coronary syndrome in young women, always obtain a detailed hormonal contraceptive history. Although the absolute risk is low, combined oral contraceptives should remain in the differential diagnosis of unexplained arterial thrombosis, and management should be individualized according to the underlying coronary pathology.
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