Massive coronary thrombosis caused primary percutaneous coronary intervention to fail in a COVID‐19 patient with ST‐elevation myocardial infarction

Abstract

COVID‐19 is a new viral infection that has a significant impact on global health and economy. Because of its rapid spread worldwide, it may influence the prognosis of other medical conditions, such as ST‐segment elevation myocardial infarction (STEMI). We report a case of a 58‐year female patient admitted with an infero‐posterior STEMI on the background of recently positive COVID‐19 swab. Reperfusion was attempted through primary PCI but unfortunately failed to restore coronary blood flow due to massive thrombotic burden despite several attempts of balloon dilatation and aspiration thrombectomy. She sadly died later on because of hemodynamic deterioration. This scenario raises concerns about Neutrophil Extracellular Traps (NETS) which might potentially have propagated inflammation and thrombosis via platelets' aggregation leading to enhanced coagulopathy and massive coronary thrombosis. Therefore, we suggest primary PCI as the first‐choice of revascularization in patients with combined COVID‐19 and STEMI. Additionally, we emphasize on the importance of using the potent new generation P2Y12 inhibitors along with GPIIb/IIIa inhibitors in every STEMI patient with COVID‐19 to achieve favorable conditions for primary PCI as well as favorable outcomes after stent implantation.

Coronary thrombosis in a young male with COVID-19

“…Gastrointestinal, neurological, and other atypical manifestations are also reported [ 2 , 3 ]. Cardiovascular manifestations are relatively rare; however, the acute coronary syndrome is reported [ [4] , [5] , [6] , [7] ]. Our patient had no risk factors for coronary artery disease but developed an acute STEMI, and PPCI revealed complete thrombosis of LAD.…”

Neutrophil extracellular traps: diagnostic and prognostic value in COVID-19

“…Считается, что чрезмерная воспалительная реакция на SARS-CoV-2 -основная причина тяжести заболевания и смерти у пациентов с COVID-19 -связана с высоким уровнем циркулирующих цитокинов, глубокой лимфопенией и значительной инфильтрацией лейкоцитов в ткани легких, сердца, селезенки, почки и др., что наблюдается при посмертном анализе. Высокий уровень НВЛ, зарегистрированный у этих пациентов, страдающих тяжелой формой ОРДС, рассматривают как критерий риска летального исхода [17,22,23]. Полученные нами результаты не противоречат этим данным, но указывают на необходимость дальнейшего детального анализа потенциальных механизмов, ассоциированных с COVID-19.…”

Thrombosis management and challenges in COVID-19 patients presenting with acute coronary syndromes

“…[ 54 ] There is only a limited number of case reports which had discussed the management of COVID-19 patients presenting with Type 1 MI. [ 63 64 65 66 67 68 69 70 71 72 73 74 75 76 ]…”

“…[ 72 ] There are several published cases demonstrating higher thrombotic features of coronary angiography findings, as presented in Tables 2 and 3 . [ 64 65 67 68 69 71 72 73 74 75 76 99 100 ]…”