PPCI involving coronary artery aneurysms (CAAs) is challenging because of difficulties in “wiring” the distal part of the lesion, the presence of extensive thrombus burden, and increased risk of distal embolization and no reflow (1). ...CAA is a risk factor for stent thrombosis after stenting for acute coronary syndromes (2). ...PPCI-treated patients with STEMI caused by CAA show unacceptable rates of early stent thrombosis causing recurrent MIs. All event rates are calculated as Kaplan-Meier estimates.BARC = bleeding academic research consortium; CL = culprit lesion; EF = ejection fraction; MI = myocardial infarction; RCA = right coronary artery. Patients With Aneurysm as CL (n = 32) Patients Without Aneurysm as CL (n = 2,280) p Value Age, yrs 65.85 ± 11.61 62.94 ± 12.52 0.17 Male 26 (81.3) 1,773 (77.8) 0.637 Diabetes mellitus 7 (21.9) 374 (16.7) 0.441 Previous MI 8 (25.8) 256 (11.4) 0.013 CL = RCA 16 (50.0) 739 (32.4) 0.035 EF at discharge, % 48.28 ± 6.63 48.56 ± 9.40 0.884 Bleeding BARC 3,5 1 (3.2) 17 (0.8) 0.13 30-day event rates Death/MI 5 (15.6) 169 (7.7) 0.091 Death 1 (3.1) 131 (6.0) 0.515 Cardiac death 1 (3.1) 105 (4.7) 0.682 New MI 4 (12.7) 50 (2.3) <0.001...