IMR Press / RCM / Volume 21 / Issue 2 / DOI: 10.31083/j.rcm.2020.02.92
Open Access Case Report
High thrombus burden despite thrombolytic therapy in ST-elevation myocardial infarction in a patient with COVID-19
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1 Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
2 Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
3 Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
*Correspondence: (Babak Azarbal)
Rev. Cardiovasc. Med. 2020, 21(2), 289–295;
Submitted: 15 May 2020 | Revised: 17 June 2020 | Accepted: 22 June 2020 | Published: 30 June 2020
Copyright: © 2020 Setia et al. Published by IMR Press.
This is an open access article under the CC BY-NC 4.0 license

Consideration of thrombolysis as first-line reperfusion therapy in patients with COVID-19 and STEMI is recommended by ACC/SCAI guidelines. We describe a patient with COVID-19, who presented with ST-elevation myocardial infarction and was treated with thrombolysis and anticoagulation. He was later found to have a significant persistent thrombus burden requiring thrombectomy and stent placement. Invasive hemodynamics on multiple high-dose pressers revealed a high cardiac output state with low systemic vascular resistance, consistent with distributive rather than cardiogenic shock. Our case illustrates that thrombolytic therapy alone may not be adequate in patients with STEMI and COVID-19, as well as the importance of early invasive hemodynamics in management of shock in patient with STEMI and COVID-19 infection.

acute coronary syndrome
ST-elevation myocardial infarction
Figure 1.
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