ArticleEuropean heart journal. Case reports2026
Acute STEMI in a young adult without conventional risk factors: a case report of JAK2-positive essential thrombocythemia.
Article in European heart journal. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The prevalence of acute coronary syndrome (ACS) in young adults (<40 years) is rising, with a substantial proportion attributable to non-atherosclerotic causes. One cause is essential thrombocythemia (ET), a myeloproliferative neoplasm (MPN) characterized by increased risk of thrombosis and bleeding. Recognizing ET as an aetiology of ACS is clinically important, as it alters acute and long-term management. This case highlights myocardial infarction as the presenting event of JAK2-positive ET in a young patient without traditional risk factors. Case summary: A 31-year-old man with no cardiovascular risk factors developed severe chest pain while weightlifting. ECG revealed anterior ST-segment elevation, and troponin peaked above 22 500 ng/L. Point-of-care ultrasound showed apical wall motion abnormality, and suprasternal notch view revealed no intimal flap. Coronary angiography showed complete ostial left anterior descending artery occlusion, treated with intravascular ultrasound-guided drug-eluting stent placement. Persistent thrombocytosis after reperfusion and at follow-up, along with absence of other risk factors, prompted haematology consultation. Hypercoagulability testing revealed a JAK2 V617F mutation. ET was confirmed by bone marrow biopsy, and hydroxyurea was initiated alongside standard post-infarction therapy. The patient recovered left ventricular function. Discussion: This case highlights the importance of considering MPNs as a potential cause of ACS in young patients without traditional cardiovascular risk factors. Management of ET-associated ACS is complex, requiring careful balance of thrombosis prevention and bleeding risk. Cytoreduction with hydroxyurea is key to secondary prevention. Current ACS guidelines do not specifically address ET-associated ACS, underscoring the need for further studies in this high-risk population.
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