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Highlights • AMI as a result of penetrating thoracic trauma is rare, but can occur secondary to an acute thrombus, even in the absence of a direct cardiac injury. • Regardless of the cause of AMI, medical management should follow current guidelines., Introduction Acute myocardial infarction (AMI) as a result of penetrating thoracic trauma (PTT) is rare; however, there have been a few reports of AMI from gunshot wounds. Presentation of case A patient without a history of coronary artery disease (CAD) presented with stab wounds to the left chest and underwent a left anterior thoracotomy, left lung wedge resection, negative pericardial window, and negative exploratory laparotomy. Shortly after leaving the operating room (OR) in a stable condition, the patient experienced a STEMI. An acute thrombus in the proximal left anterior descending (LAD) artery was identified. Discussion AMI as a result of trauma, both blunt and penetrating, is extremely rare. There have been more reports of AMI secondary to blunt trauma, but it is much less common to find reports in literature of AMI from PTT. Conclusion AMI as a result of penetrating trauma is rare, but can occur secondary to an acute thrombus, even in the absence of a direct cardiac injury. MI should be a consideration in patients with penetrating trauma to the chest, regardless of the intensity of the trauma. At minimum, a 12-lead electrocardiogram (ECG) and a baseline troponin should be obtained at initial evaluation and post-operatively, if surgically managed. If ECG demonstrates findings concerning for MI, it should be followed with an echocardiogram and/or cardiac angiogram to further help guide management, with an early cardiology consultation.