Acute ST elevation myocardial infarction (STEMI) from simultaneous thrombosis of more than one coronary artery is an uncommon entity. The outcome can be devastating due to the large myocardium that is affected. The mechanism of simultaneous multivessel coronary occlusion is not clear. We should consider conditions such as essential thrombocythemia, multivessel spasm, hypercoagulable state, cocaine abuse, endocarditis, left ventricular clot emboli, or a paradoxical emboli. Traditional risk factors such as diabetes, hyperlipidemia, and smoking also play a role. Here we describe two cases wherein simultaneous thrombotic occlusion were noted in the same setting.