Buerger's disease is a small and medium vessel vasculitis that predominantly involves the distal extremities. Coronary involvement is rarely reported. We reported a 32 year-old man with Buerger's disease (thromboangiitis obliterans) suffering from acute anterior chest pain and V(1-6) ST-segment elevation. Frequent episodes of accelerated idioventricular rhythm (AIVR) were found during initial admission. Emergent coronary angiography revealed thrombus inside the proximal left anterior descending coronary artery and primary percutaneous trasluminal coronary angioplasty and stenting was successfully done after thrombus aspiration. No more AIVR occurred after the procedure. Doctor should be alerted to AIVR as a sign of reperfusion in the acute coronary syndrome even in a young subject.
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