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Case report
Coronary artery thrombus resulting in ST-elevation myocardial infarction in a patient with COVID-19
  1. Clara Green1,
  2. Adnan Nadir2,
  3. Will Lester3 and
  4. Davinder Dosanjh1
  1. 1Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Clara Green; clara.green{at}nhs.net

Abstract

COVID-19 is a prothrombotic condition that is also associated with raised troponin levels and myocardial damage. We present a case of a 54-year-old man who was admitted with respiratory failure due to COVID-19 and developed a ST-elevation myocardial infarction (STEMI) during his admission. His coronary angiogram did not show any significant coronary artery disease other than a heavily thrombosed right coronary artery. In view of heavy thrombus burden, the right coronary artery was treated with thrombus retrieval using a distal embolic protection device in addition to manual thrombectomy and direct (intracoronary) thrombolysis without the need for implantation of a coronary stent. After successful revascularisation, triple antithrombotic therapy was instituted with an oral anticoagulant in addition to dual antiplatelets. This case illustrates the association of COVID-19 with coronary artery thrombosis, which may require disparate management of a STEMI than that resulting from atherosclerotic coronary artery disease.

  • interventional cardiology
  • ischaemic heart disease
  • COVID-19

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-243811

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    Footnotes

    • Twitter @ClaraEGreen, @Dr_D_Dosanjh

    • Contributors Conceptualisation: CEG and DD; writing—original draft preparation: CEG; writing—review and editing: AN, WL and DD; preparation of figures: AN; supervision: AN and DD.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.