Harry Spoelstra: Omicron COVID-19 and Coronary Thrombosis Without Atherosclerosis
Harry Spoelstra, CardioVascular Surgeon, shared a post on X about a recent article by Ming-Lian Gonget al, published in Journal of Medical Case Reports, adding:
”Coronary thrombosis without underlying atherosclerotic plaque in patients with Omicron variant of coronavirus disease 2019: a case series
As I’ve warned you, Omicron COVID-19 can trigger massive heart attacks in patients with perfectly clean arteries. More evidence below.
This small case series preprint describes three Chinese patients with Omicron-variant COVID-19 who developed acute myocardial infarction (AMI) caused by coronary thrombosis without underlying atherosclerotic plaque on coronary angiography (CAG).
Case Details:
- 33-year-old man: mild chest pain with a massive thrombus in the left anterior descending (LAD) artery (TIMI 2 flow), which resolved spontaneously with antithrombotic therapy.
- 76-year-old man: severe COVID-19 pneumonia and AMI complicated by ventricular septal defect and cardiogenic shock, with no plaque in any vessel.
- 76-year-old woman (history of atrial fibrillation): AMI from right coronary artery thrombus plus venous thromboembolism, and repeat CAG confirmed thrombus resolution without plaque.
Key Findings:
- All patients showed ST-elevation or equivalent AMI on ECG.
- Echocardiography revealed regional wall-motion abnormalities (plus VSD in one case).
- Thrombosis resolved with anticoagulation (heparin/rivaroxaban) plus dual antiplatelet therapy.
- No stenting or thrombectomy was needed in most cases.
Mechanisms and Management:
- Omicron-driven cytokine storm induces endothelial damage and hypercoagulability, enabling de novo thrombosis.
- Prompt CAG, primary PCI when feasible, intensive antithrombotic therapy, and a multidisciplinary Heart Team approach were critical.
Conclusion:
- Omicron-variant COVID-19 markedly increases thrombogenicity, causing coronary thrombosis and AMI even in the absence of atherosclerotic plaque.
- Early recognition, aggressive anticoagulation/antiplatelet therapy, and coordinated Heart Team care enable favorable outcomes despite high-risk presentations.
- The report underscores the need for heightened vigilance for thrombotic complications in COVID-19.
Title: Coronary thrombosis without underlying atherosclerotic plaque in patients with Omicron variant of coronavirus disease 2019: a case series
Authors: Ming-Lian Gong, Yi Mao
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