ABSTRACT
Coronary artery anomalies (CAAs) comprise a diverse group of congenital malformations with widely varying expressions and pathophysiological mechanisms. The most notable group of CAAs has been termed ‘Anomalous coronary artery originating from the opposite sinus of Valsalva’ (ACAOS), a rare congenital heart disease that is associated with sudden cardiac death and ischemia. We present the case of an 80-year-old man presenting with inferior STEMI having a single coronary ostium and a rare variant of the coronary artery origin belonging to type A4d with an interatrial LAD course according to Angelini's classification. This abnormal finding was managed conservatively and the patient underwent successful drug-eluding stent implantation in the culprit right coronary artery in its middle portion.