Hyperhomocysteinemia as the only risk factor in a young man presenting with ST-elevation myocardial infarction.

Hyperhomocysteinemia has been established as a risk factor for cardiovascular events. This case of a 23-year-old male, presenting with acute coronary thrombosis and unremarkable past medical history, highlights the importance of measuring homocysteine levels in young individuals with acute coronary syndromes, especially those without conventional risk factors. <Learning objective: Hyperhomocysteinemia could be rarely the only risk factor causing an acute coronary syndrome, especially in very young individuals; Optical coherence tomography could provide valuable information regarding the cause of occlusion in an unexpected clinical presentation; Gene testing for thrombophilia should be considered for very young individuals with acute coronary syndrome without conventional risk factors; Randomized controlled trials have failed to prove a clinical benefit in patients treated with folic acid.>.