Most ST-elevation myocardial infarctions are related to atherothrombosis and benefit from emergent percutaneous coronary intervention. On the other hand, type-A aortic dissection is a less frequent but deadly disease requiring emergent surgery. In the present case, we aimed to report the case of a patient who presented with aortic dissection responsible for STEMI and cardiogenic shock related to a compressive hematoma of the left main trunk. This atypical case underlines the need for careful assessment of the aorta in case of left main trunk occlusion in patients without evidence of atheroma in the other coronary segment. Unfortunately, in this case, refractory cardiogenic shock postponed surgical repair and led to the patient's death.