Cocaine increases the risk of cardiovascular diseases, including myocardial infarction. We herein describe a case of a 22-year-old man with a long history of cocaine abuse. He presented at our institution because of acute coronary syndrome with ST segment elevation. Emergency coronary angiography revealed ostial occlusion of the left anterior descending artery, which required desobstruction and implantation of a bare metal stent. Angioplasty was complicated 4 months later by in-stent restenosis requiring reintervention. This case highlights myocardial infarction as a cocaine-induced effect. Appropriate treatment and cessation of cocaine abuse may prevent cardiovascular complications and recurrences.