Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11508
Peer-review started: May 12, 2022
First decision: June 27, 2022
Revised: July 27, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: November 6, 2022
Processing time: 167 Days and 10.2 Hours
Occurring in approximately 30% of hospitalized patients, cardiovascular complications that take place during the course of coronavirus disease 2019 (COVID-19) have been shown to cause morbidity and mortality. This case is the first report of extensive right coronary artery (RCA) thrombosis that was evaluated by intracoronary imaging and intracoronary invasive physiology in a patient with COVID-19.
A 62-year-old woman presented with flu-like symptoms; ten days later, she presented with inferior ST-segment elevations, chest pain, dyspnea, nausea and vomiting. The patient was diagnosed with COVID-19 following a positive test result. Emergency angiography of the RCA and its branches indicated intraluminal filling defects, suggesting a thrombus. Intravascular ultrasound confirmed a subacute thrombus in the RCA, the right posterior descending branch and the right posterior ventricular (RPV) branch. There was also an acute thrombus in the RPV branch and atherosclerosis in the RCA. Dual antiplatelet/ anticoagulation therapy was administered. After 7 d, angiography revealed complete disappearance of the thrombi. Optical coherence tomography confirmed this with the exception of a small thrombus in the RPV branch and atherosclerotic plaque in the RCA. The atherosclerotic RCA was measured using the resting full-cycle ratio, indicating no impairment to coronary physiology. The patient was discharged on the 11th day of hospitalization and remained asymptomatic through the 6-mo follow-up.
This was the first report of RCA thrombosis in a patient with COVID-19. Dual antiplatelet/anticoagulation therapy was successful.
Core Tip: Cardiovascular complications occurring during the course of coronavirus disease 2019 (COVID-19) cause morbidity and mortality. We report the case of a 62-year-old woman with COVID-19 and ST-elevation myocardial infarction. Angiography of the right coronary artery suggested a thrombus, and findings were confirmed via intravascular ultrasound and optimal coherence tomography. Dual antiplatelet therapy and anticoagulation with enoxaparin therapy was administered for 7 d, followed by disappearance of the thrombi. Resting full-cycle ratio was performed without damage to coronary physiology. There is no consensus on the ideal management approach for acute coronary syndrome in this scenario; however, in this case the thrombi disappeared after dual antiplatelet and anticoagulation therapy.