Background: Double myocardial infarction involving two culprit major vessels is a rarely reported presentation with high incidence of mortality.
Case Report: In this study, we report 47-year-old male patient who had an attack of chest pain associated with ST-segment elevation in the antero-lateral leads. Pharmaco-invasive reperfusion approach was adopted with full dose tissue plasminogen activator, followed by transferring the patient to a specialized heart center for Percutaneous Coronary Intervention (PCI). Coronary angiography showed a fresh thrombus totally occluding Left Anterior Descending (LAD) and another thrombus causing distal total occlusion of a dominant Right Coronary Artery (RCA). Two Bare metal stents were placed in both lesions with Thrombolysis in Myocardial Infarction (TIMI) 3 flow post dilatation, but the patient, unfortunately, went into Ventricular Fibrillation (VF) followed by asystole and died 35 minutes later.
Conclusions:  Acute double vessel coronary artery thrombosis is a serious event that requires prompt diagnosis and management to prevent its complications.

Keywords: multiple plaques rupture, double coronary thrombosis, coronary occlusion