From Nonobstructive Plaque to LAD Thrombosis in a 26-Year-Old Athlete

BACKGROUND: Stimulants and anabolic steroids have a role in plaque disruption resulting in acute coronary syndrome in young adults. CASE SUMMARY: A 26-year-old bodybuilder with heavy use of anabolic steroids and energy drinks presented with chest pain and ST-segment changes. Coronary angiography revealed minimal nonobstructive plaque in the proximal left anterior descending artery and left ventricular systolic dysfunction. He was started on guideline-directed medical therapy and counseled to discontinue toxic exposures. Weeks later, he presented with recurrent chest pain and was found to have an acute thrombotic occlusion of the mid-left anterior descending artery requiring urgent revascularization and a drug-eluting stent placement. DISCUSSION: This case highlights how synergistic stimulant and anabolic exposure can create dynamic coronary pathology and contribute to endothelial injury, hypercoagulability, and accelerated atherosclerosis. TAKE-HOME MESSAGES: Nonobstructive coronary findings do not exclude imminent coronary thrombosis in high-risk young adults. Risk factor cessation and close follow-up are essential.