Déjà vu: is your patient a twin?

Coronary artery disease is the leading cause of death worldwide. Hereditary and environmental factors have a strong impact on coronary artery disease development. The exact incidence of this disease and its characteristics among identical twins is unknown. Despite a limited amount of documented cases, several characteristics can be drawn: coronary artery disease is expressed at an early age, the onset of symptoms occurs within a short time span between the twins, the coronary pathology is often very similar and the metabolic and biochemical profiles are generally alike. We present a case of identical male twins with a near simultaneous clinical presentation of coronary artery disease, who initially underwent unsuccessful percutaneous coronary intervention due to chronic total occlusion and finally, coronary artery bypass grafting. In the case of identical twins, it is imperative to aggressively screen the asymptomatic twin of the symptomatic patient irrespective of young age or absence of symptoms.