Acute myocardial infarction following sequential multi-vessel occlusion in a case of polycythemia vera

A 59-year-old female was brought to our emergency room with severe chest pain. Based on the electrocardiogram (ECG) and echocardiography, an acute coronary syndrome (ACS) was suspected. Her initial ECG showed ST elevation in the inferior leads (II, III, and aVF), which had progressed to involve the anterior leads (V2-V4) by the time she was shifted to the catheterization room. A coronary angiogram revealed total occlusion of the mid-left anterior descending (LAD) artery and a filling defect of the distal right coronary artery. Although we had emergently treated her using thrombus aspiration following stent implantation, lots of thrombi re-formed on the stent. We surmised her ACS was primarily caused by thrombus formation due to polycythemia vera (PV) based on the presence of increased blood consistency on admission. We performed repetitive long-inflation using a perfusion balloon and repeated thrombus aspiration. Finally, she was diagnosed as an untreated case of PV as a result of detailed blood investigations. Thereafter, we successfully treated her using the combination of dual antiplatelet therapy and direct oral anticoagulant therapy. Our experience highlights the importance of an urgent identification of PV. Effective management strategies should be successfully implemented in such patients as soon as possible. <Learning objective: Polycythemia vera (PV) is an idiopathic, chronic myeloproliferative disease characterized by an increased red blood cell count and hematocrit, which in turn causes systematic thrombosis. A resultant acute myocardial infarction is therefore complicated and difficult to manage, due to the patient's continuous hypercoagulable state. In the absence of a defined treatment approach, newer and successfully implemented strategies for the management of consequent thrombotic events in PV patients are indispensable to clinicians.>.