ST-Elevation Myocardial Infarction With Premature Multivessel Coronary Artery Disease in a Female Personal Trainer Using Anabolic-Androgenic Steroids: A Case Report

Non-medical use of anabolic-androgenic steroids (AAS) is common among recreational athletes and fitness professionals and has been associated with premature atherosclerosis and acute coronary events. Most published cases involve men. We report the case of a 46-year-old female personal trainer with no known cardiovascular risk factors and no family history of coronary disease who developed sudden, intense chest pain during exercise. She was diagnosed with inferior ST-elevation myocardial infarction (STEMI) and received dual antiplatelet therapy, anticoagulation, and prehospital fibrinolysis with alteplase. On direct questioning, she reported regular non-prescribed use of oxandrolone, nandrolone decanoate, and a testosterone ester blend. High-sensitivity troponin I was 32,196.7 ng/L on admission, and laboratory tests also showed erythrocytosis and a low high-density lipoprotein cholesterol level. Coronary angiography showed multivessel disease, including a 90% stenosis of the mid right coronary artery, 80% stenoses of the mid circumflex and proximal first diagonal arteries, and an occluded second diagonal branch. She underwent successful percutaneous coronary intervention with drug-eluting stents in the right coronary and circumflex arteries and was discharged on day six. Two months later, she remained abstinent and asymptomatic, but myocardial perfusion scintigraphy showed a moderate area of inducible ischemia and a moderate area of fibrosis. This case shows that extensive coronary disease can develop in a woman without previously known classical risk factors who uses AAS. Clinicians should ask directly about AAS use in patients with premature or unexplained acute coronary syndromes, including women.