We report a case of a 23-year-old Filipino male with no known comorbidities who presented with acute-onset chest pain following basketball. He was a former cigarette smoker with a one year history of daily vaping, consuming one pod in two weeks.  On physical examination, blood pressure on all extremities were 110-120/70-80mmhg, no evidence of xanthelasma, corneal arcus senilis, or tendon xanthomas. The rest of the physical examination was unremarkable.  

Electocardiography revealed anteroseptal ST elevation, and laboratory testing showed elevated troponin -T (initial: 118 ng/dL; 6 hours: 1,094ng/dl0 and high sensitive C-reactive protein (6.24mg/L) Transthoracic echocardiography showed mild anterior hypokinesia with preserved ejection fraction 59%. Chest xray was normal.  
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Coronary angiography demonstrated severe (80-90%) mid-left anterior descending (LAD) artery stenosis. A 4.0 x 3.3mm drug-eluting stent deployed at mid-LAD, 4.0 x 12mm stent at the proximal to mid LAD. 

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The right radial artery was accessed via modified Seldinger’s technique using 6F transradial introducer sheath. Routine coronary angiography was done using a 5F Tiger diagnostic catheter, with a 0.035 x 150cm J-tip diagnostic guidewire.  revealed a severe (80-90%) eccentric stenosis in the mid-LAD. Coronary angioplasty of the proximal to mid LAD was done successfully using a 6F Launcher EBU3.5 guiding catheter, with a 180cm x 0.014in Sion PTCA wire. Denovo stenting of the mid LAD was done successfully by deploying a 4.0mm x 33mm Xience Xpedition stent at 10 atm. Further pre-dilatation of the mid LAD was done successfully using a 2.5mm x 12mm Emerge MR balloon at 20-24 atm. The second drug-eluting stent, a 4.0mm x 12mm Xience Xpedition stent was then successfully deployed at the proximal to mid LAD at 15-16 atm. Post-dilatation of the proximal to mid LAD was done successfully using a 4.0mm x 8mm NC Trek balloon at 20-26 atm. The balloon delivery system, guiding catheter and PTCA wire were removed. Post injection of coronaries was done. Due to the paucity of the risk factors, the heart team decided to pursue for other non-traditional risk factor, protein C, S and factor V leiden  were normal suggesting atherothrombotic over hypercoagulable etiology, lipoprotein(a) on the other hand was elevated at 157.55nmol which puts the patient at high risk to develop cad, stroke or peripheral arterial disease.
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This case underscores the importance of considering emerging cardiovascular risk factors, such as vaping and elevated Lipoprotein (a) in young adults presenting with STEMI. Early recognition and management of these risks, along with prompt revascularization are crucial to prevent adverse outcomes. greater awareness and routine assessment of Lp(a) may aid in risk stratification and early intervention in younger population.