• Seok Oh, Ju Han Kim, Min Chul Kim, Young Joon Hong, Youngkeun Ahn, and Myung Ho Jeong.
• Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
• Medicine (Baltimore). 2021 Jul 9; 100 (27): e26604e26604.

RationaleCongenital agenesis of the right coronary artery (CARCA) initially presenting as acute myocardial infarction (AMI) due to total occlusion is a rare clinical condition that can lead to severe complications, including death. We report a case of successful percutaneous coronary intervention (PCI) in a patient with this condition.Patient ConcernsA 57-year-old man was admitted to our center with chest pain that had occurred several hours prior. Since he was initially diagnosed with AMI with ST-segment elevation, we promptly commenced coronary angiography (CAG).DiagnosisCAG revealed the absence of a right coronary artery (RCA). In the left coronary cusp area, the left circumflex coronary artery (LCX) was occluded totally.InterventionsWe performed PCI for total occlusion of the proximal part of the LCX. Follow-up CAG showed a superdominant branch of the LCX, sprouting into the RCA territory.OutcomesThe patient was discharged uneventfully after successful PCI.LessonsCARCA with AMI, which is an extremely unusual case, can be fatal; however, PCI seems to be an effective treatment option.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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