Coronary thrombosis without underlying atherosclerotic plaque in patients with Omicron variant of coronavirus disease 2019: a case series

Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state that predisposes patients to thrombotic events, including acute myocardial infarction (AMI). In patients with COVID-19 presenting with ST-segment elevation myocardial infarction, coronary artery angiography often reveals significant thrombosis, which may occur in the presence or absence of underlying obstructive atherosclerotic plaques. We report a case series of three Chinese patients with the Omicron variant of COVID-19 infection who presented with acute myocardial infarction due to coronary thrombosis without underlying atherosclerotic plaque on coronary angiography. The first case involved a 33-year-old man with Covid-19 who had coronary thrombosis without underlying atherosclerotic plaque on coronary angiography. The second case was a 76-year-old man who developed infarct related ventricular septal defect and cardiogenic shock following acute myocardial infarction (AMI). The third case was a 76-year-old woman with AMI who was also found to have venous thromboembolism. All patients were discharged and continued to improve symptomatically on follow-up phone conversations. This case series highlights that infection with the Omicron variant of COVID-19 virus (especially its critical and severe type) can increase thrombogenicity and contribute to coronary thrombosis without underlying atherosclerotic plaque. Prompt diagnosis and appropriate treatment such as primary percutaneous coronary intervention are essential. Effective anticoagulant and antiplatelet drug therapy before, during and after reperfusion therapy is a key principle. The utilization of a “Heart Team” approach ensures systematic management, discussion of therapeutic options, hemodynamic stability, and durable outcomes.