A 28-year-old female, addict to cocaine and with acute myocardial infraction is reported. The patient was obese and smoked 17 cigarette packs per year. She had been consuming about 250 mg of cocaine daily for the last months until 2 weeks before admission. Coronary angiography showed a 100% stenosis of the left anterior descending artery. Although the vasospastic effect of cocaine on the pathogenesis of coronary ischemia in addicts is well known, most patients reported in the literature show coronary artery stenosis. This may lead to hypothesize about a likely atherogenic role of cocaine.