Coronary fistula consists of an abnormal arterial communication, via one or more branches, to places like the trunk of a pulmonary artery, coronary sinus, vena cava, pulmonary veins or directly to a heart chamber.It is a rare condition, of congenital or acquired origin.Due to their low incidence they are underdiagnosed, symptoms are attributed to other causes.When required, treatment is surgical resection or percutaneous closure.A case where the finding of a coronary fistula is carried out in the context of ST-elevation acute myocardial infarction is described, increasing complexity of management and approach.