Coronary artery disease (CAD) commonly occurs in individuals over the age of 45 years. Several studies categorize “young” individuals with CAD or acute myocardial infarction as those below the ages of 40 and 45. The protection provided by young age has slowly been eroded by risk factors like smoking, obesity, and sedentary lifestyle that are becoming more common among young individuals. We report a case of 21-year-old male with family history of premature coronary artery disease, who presented with acute anterior wall ST elevation myocardial infarction. Coronary angiogram revealed 100% thrombotic occlusion of proximal left anterior descending coronary artery. Further evaluation of the lesion morphology using optical coherence tomography revealed plaque erosion. Thrombolysis in Myocardial Infarction coronary grade III flow was achieved after thrombus aspiration. Stent deployment was deferred to avoid the need for lifelong medication and its associated side effects in a young patient. Due to their anti-thrombotic qualities, we also recommend using novel oral anticoagulants in this situation for short-term therapy.