Anterior STEMI (ST-segment elevation myocardial infarction) is associated with the worst prognosis of all infarction locations. We report the case of a 37-year-old male patient who presented for two hours of severe chest pain and was diagnosed with Killip I anterior STEMI in the emergency room. The emergency coronary angiogram revealed acute thrombotic ostial LAD (left anterior descending artery) occlusion and acute thrombotic ostial ramus intermedius (RI) near-occlusion. Thrombus aspiration for the LAD occlusion was performed and a large thrombus was extracted, followed by the artery’s reperfusion. However, we noticed that there was a large diagonal branch providing septal perforating arteries and that there was a distal LAD occlusion. We implanted a drug-eluting stent on the site of the proximal LAD lesion, but we could not obtain any flow in the distal occluded LAD. The patient underwent dual antiplatelet and unfractionated heparin treatment, and, 8 days later, we performed another coronary angiogram. To our surprise, there was very few residual thrombi in the previously occluded LAD segment, and there was no more thrombus in the RI. We noticed TIMI 3 flow in all coronary arteries and an increase in the patient’s left ventricular ejection fraction was also recorded.

COVID-19 is a systemic disease encompassing a wide spectrum of manifestations, from asymptomatic to severe organ dysfunction and death. Thromboembolic complications are frequent, but there is a great variability of individual risk and severity. We present the case of an adult male with recovered SARS-CoV-2 infection, which developed late thrombosis in several arterial and venous sites, with unfavorable outcome. The mechanisms involved in COVID-19 hypercoagulable state are discussed.