Very Young ST-Segment Elevation Myocardial Infarction Associated With Chronic Nonmedical Anabolic-Androgenic Steroid Use: A Case Report.

Abstract

Myocardial infarction (MI) before the age of 40 years is uncommon and warrants a comprehensive evaluation of potential etiologies. Chronic nonmedical anabolic-androgenic steroid (AAS) use has been associated with endothelial dysfunction, accelerated atherosclerosis, and a prothrombotic state, all of which may contribute to premature coronary artery disease. A 29-year-old man with no known medical history and approximately two years of nonmedical testosterone and stanozolol use presented with acute chest pain. Electrocardiography revealed an anterior ST-segment elevation myocardial infarction (STEMI). Emergency coronary angiography demonstrated a thrombotic total occlusion of the mid-left anterior descending coronary artery. Primary percutaneous coronary intervention restored coronary blood flow. The patient presented with Killip class II acute heart failure requiring temporary continuous positive airway pressure (CPAP) and inotropic support. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction (LVEF) of 30-35%, with anterior and apical hypokinesia. Admission laboratory tests revealed marked atherogenic dyslipidemia (total cholesterol, 302 mg/dL; low-density lipoprotein cholesterol, 250 mg/dL; high-density lipoprotein cholesterol, 29 mg/dL; triglycerides, 113 mg/dL; and non-high-density lipoprotein cholesterol, 273 mg/dL). In addition to the culprit lesion, nonobstructive atherosclerotic plaques were identified in other coronary segments. At the one-month follow-up, low-density lipoprotein cholesterol had decreased to 85 mg/dL following statin therapy and the reported discontinuation of AAS use. At three months, the patient remained clinically stable, although LVEF remained at 30%. AAS exposure may have contributed to accelerated atherosclerosis and coronary thrombosis in a susceptible young individual. However, alternative causes of MI at a very young age should be systematically considered.