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Massive coronary thrombosis caused primary percutaneous coronary intervention to fail in a COVID-19 patient with

Sherif Seif1,2, Ahmed Ayuna3, Abhishek Kumar2

  • 1Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 31, 2020
PubMed

Insights

A COVID-19 patient with ST-segment elevation myocardial infarction (STEMI) experienced failed reperfusion due to severe thrombosis. This case highlights the potential role of Neutrophil Extracellular Traps (NETs) in COVID-19-associated coagulopathy.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Hematology

Background:

  • COVID-19 (Coronavirus Disease 2019) is a novel viral infection with significant global health and economic impacts.
  • The rapid worldwide spread of COVID-19 may influence the prognosis of other medical conditions, including ST-segment elevation myocardial infarction (STEMI).

Observation:

  • A 58-year-old female patient presented with infero-posterior STEMI following a recent positive COVID-19 test.
  • Primary percutaneous coronary intervention (PCI) failed to restore coronary blood flow due to a massive thrombotic burden, despite multiple interventions.
  • The patient experienced hemodynamic deterioration and unfortunately died.

Findings:

  • The case suggests a potential role for Neutrophil Extracellular Traps (NETs) in propagating inflammation and thrombosis in COVID-19 patients.
  • NETs may contribute to platelet aggregation, enhanced coagulopathy, and massive coronary thrombosis observed in STEMI cases co-infected with COVID-19.
  • Massive thrombotic burden poses a significant challenge to standard reperfusion therapies in STEMI patients with COVID-19.

Implications:

  • Primary PCI should be considered the first-choice revascularization strategy for patients with concurrent COVID-19 and STEMI.
  • The use of potent new-generation P2Y12 inhibitors and GPIIb/IIIa inhibitors is emphasized for STEMI patients with COVID-19.
  • Aggressive antithrombotic therapy may be crucial for achieving favorable outcomes in STEMI patients with COVID-19 undergoing primary PCI.

Keywords:
acute myocardial infarctionantithrombotic treatmentneutrophil extracellular trapsprimary percutaneous coronary interventionviral infection

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