Combined oral contraceptive use as a cause of acute myocardial infarction in a young woman without traditional risk factors: a case report.

BACKGROUND: Combined oral contraceptives are widely used and generally considered safe. However, they have been associated with arterial thrombosis, including myocardial infarction, particularly in women with cardiovascular risk factors. This case adds to the limited literature highlighting the potential for combined oral contraceptive-induced myocardial infarction in individuals without traditional cardiovascular risk factors. A 28-year-old non-smoking Iranian woman with no significant medical history presented with 11 h of typical anginal chest pain radiating to the left arm and interscapular area. Electrocardiography revealed ST-segment elevations in leads V2-V5, and cardiac biomarkers confirmed myocardial infarction. She had been taking a second-generation combined oral contraceptive containing 150 µg levonorgestrel and 30 µg ethinyl estradiol for 13 years. Emergent coronary angiography demonstrated a thrombotic occlusion in the mid-left anterior descending artery without evidence of underlying atherosclerosis. Successful reperfusion was achieved via balloon angioplasty without stenting. The patient remained stable, was discharged on optimal medical therapy, and advised to discontinue combined oral contraceptives. At 3-month follow-up, cardiac Computed Tomography Angiography revealed a patent left anterior descending artery with no residual stenosis, and echocardiography showed improved systolic function.

CONCLUSIONS: This case underscores the potential for thrombotic myocardial infarction in young women using combined oral contraceptives, even in the absence of conventional risk factors. It highlights the importance of considering hormonal contraceptive history in the diagnostic workup of acute coronary syndromes in young females. In addition, it demonstrates that Balloon angioplasty without stent placement may be effective in selected cases of non-atherosclerotic thrombotic occlusion.