We describe the case of a patient presenting with acute myocardial infarction complicated by cardiogenic shock in the setting of an unknown bioprosthetic aortic valve endocarditis and in absence of obstructive coronary artery disease. Given the angiographic finding, the most likely etiology was external compression by a perivalvular abscess, which was confirmed during autopsy. Although rare, coronary artery compression should be considered in the differential diagnosis of acute coronary syndromes complicating infective endocarditis.