Coronary artery anomalies (CAAs) are a rare angiographic finding, sometimes associated with acute coronary events. We report on a case of primary angioplasty for inferior acute myocardial infarction (AMI) in a 66-year-old woman with a solitary coronary ostium in the right sinus of Valsalva and a "superdominant" right coronary artery. We also discuss two potential pitfalls of primary angioplasty: correct interpretation of coronary anatomy and approach to challenging lesions.