COVID-19 Infection and High Intracoronary Thrombus Burden

Highlights: • Coronavirus 2019 is associated with an increase in thrombotic events. • The cytokine storm and endothelial dysfunction are central to high thrombus burden. • Increased coronary plaque instability and rupture has been seen in viral studies. • High intracoronary thrombus burden is associated with worse cardiac outcomes. Coronavirus 2019 (COVID-19) is an acute respiratory disease that has rapidly spread around the world and been declared a global pandemic by the World Health Organization. Emerging evidence demonstrates a strong association with a pro-thrombotic state and we present the first patient admitted with COVID-19 and an inferior ST-segment elevation myocardial infarction (STEMI) with evidence of high intracoronary thrombus burden. We review the mechanism of the high thrombus burden, which may be driven by the significant cytokine storm, endothelial dysfunction, increase risk of coronary plaque rupture and hypercoagulability.