We report tow cases of infective endocarditis (IE) presenting as acute coronary syndrome (ACS). Case 1: A 60-year-old man with the diagnosis of mitral IE complicated by an ST segment elevation myocardial infarction. Primary percutaneous coronary intervention with aspiration of the thrombus at the distal leftanteriordescending (LAD) arterywas successfully performed. Case 2: A 72 year old man was admittedfor an aortic root abscess compressing the left coronary artery. The treatment required surgery, including coronary artery bypass procedure. The postoperative course was complicated by multiple organ failure, and the patient died after 48 h.