Recurrent, isolated left main coronary artery stenosis in a young female

A 21-year-old female with no prior cardiac history presented multiple times with chest pain and elevated cardiac biomarkers. Single-photon emission computed tomography revealed a reversible perfusion defect, and coronary angiography was attempted, but was aborted. After multiple similar presentations without angiography, the patient suffered ST-elevation myocardial infarction. Coronary angiography revealed 99% subtotal occlusion of the left main coronary artery and a reduced ejection fraction of 20% complicated by cardiac arrest and cardiogenic shock requiring mechanical circulatory support-assisted percutaneous coronary intervention and veno-arterial extracorporeal membrane oxygenation as a bridge to recovery. An extensive workup did not reveal any secondary causes. Despite frequent follow-up and strict adherence to dual antiplatelet therapy, she developed recurrent angina and was found to have severe in-stent restenosis of the left main coronary artery, requiring two-vessel coronary artery bypass grafting. Despite normal blood counts prior to surgery, post-surgical labs revealed blast-phase acute myeloid leukemia, prompting the initiation of chemotherapy.