Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test?

BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.

Does the intracoronary pressure differ according to two types(diffuse or focal)of coronary spasm?

BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear whether intracoronary pressure differs between the two spasm types.AIM To investigate such relationships using a pressure wire during the spasm provocation test(SPT)in patients with VSA.METHODS Eighty-seven patients with VSA(average age:67 years;50 men,37 women)underwent SPT.During the SPT,a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery,and the ratio of the intracoronary pressure to the aortic pressure(Pd/Pa)was continuously monitored.An SPT was performed using acetylcholine(ACh),and the presence of coronary spasm was defined as the presence of>90%arterial narrowing in response to an ACh infusion,with the usual chest symptoms and/or ischemic ECG changes.Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification,while diffuse spasm was defined as>90%spasm with two or more segments.RESULTS Among 87 patients,the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group(n=33)than in the diffuse spasm group(n=54,P<0.05).In the vessel analyses,in these 134 spastic segments,diffuse and focal spasms were detected in 100 and 34 vessels,respectively.The Pd/Pa at baseline was similar in both groups(diffuse:0.96±0.05,focal:0.95±0.05,P=0.35);however,the Pd/Pa during coronary spasm was lower in focal spastic vessels(0.66±0.20)than in diffuse spastic vessels(0.76±0.11,P<0.01),and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels(-0.29±0.20)than in diffuse spastic vessels(-0.18±0.11,P<0.01).The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the intracoronary pressure during coronary spasm.

Evaluation of Clinical Outcomes of ses Stent in Patients with Coronary Artery Disease After Intracoronary Stenting in Small Vessels

Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

BACKGROUND:Acute kidney injury following percutaneous coronary intervention(PCI) is associated with a worse outcome.However,the risk factors and outcomes of acute kidney injury(AKI) in patients after intracoronary stent implantation are still unknown.METHODS:A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine.Those were excluded from the study if they had incomplete clinical data.The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI.The parameters of the patients included:1) pre-operative ones:age,gender,hypertension,diabetes mellitus,cerebrovascular disease,left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate(eGFR),hyperuricemia,proteinuria,emergency operation,hydration,medications(ACEI/ARBs,statins);2) intraoperative ones:dose of contrast media,operative time,hypotension;and 3) postoperative one:hypotension.The parameters were analyzed with univariate analysis and multivariate logistical regression analysis.RESULTS:Of the 325 patients,51(15.7%) developed AKI.Hospital day and in-hospital mortality were increased significantly in the AKI-group.Univariate analysis showed that age,pre-operative parameters(left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate,hyperuricemia,proteinuria,hydration),emergency operation,intraoperative parameters(operative time,hypotension) and postoperative hypotension were significantly different.However,multivariate logistic regression analysis revealed that increased age(OR=0.253,95%CI=0.088-0.727),pre-operative proteinuria(OR=5.351,95%CI=2.128-13.459),pre-operative left ventricular insufficiency(OR=8.704,95%CI=3.170-23.898),eGFR<60 ml/min/1.73 m^2(OR=6.677,95%CI = 1.167-38.193),prolonged operative time,intraoperative hypotension(OR=25.245,95%CI=1.001-1.034) were independent risk factors of AKI.CONCLUSIONS:AKI is a common complication and associated with ominous outcome following intracoronary stent implantation.Increased age,pre-operative proteinuria,pre-operative left ventricular insufficiency,pre-operative low estimated glomerular filtration rate,prolonged operative time,intraoperative hypotension were the significant risk factors of AKI.

INTRACORONARY STENT PLACEMENT IN THE RECOVERY PERIOD AFTER ACUTE MYOCARDIAL INFARCTION

Angiography and intracoronary arena was performed in 16 patients in therecovery period after acute myocardial infarction in our hospital fromNovember 1995 to October 1997.The group comprised 16 men.mean age was52.7±11.8 years.Six had postinfarction angina,ten had postinfarction heartfailure.The infart-related vessel was single in 15 cases.8 in LAD.5 inRCA.2 in LCX,infact-related veasel was double in 1 case,LAD+RCA.MeanLesion length was 19.5±5.3mm and average diameter stenosis beforeprocedure was 92.5±5.1%.Nineteen intracoronary atents were implanted.10in LAD.7 in RCA,2 in LCX.Three patients received 2 stents,respectively.The procedure succese rate was 100%.After the stente implanting,averagediameter stenosis decreased to 0-10%.postinfarct angina disappeared,In thepostinfart heartfailure group,the diameter of left atrial and left vertricularon the UCG were reduced,enjection fraction increased significantly.Ourresults indicate that intracoronary stent in the recovery period aftermyocadial infarction provides a benefial effcct in increasing coronary bloodflow.preventing left ventricular function and reducing mortality Ascompared with sngioplasty.coronary stent placement has a higher clinicalsuccses rate and reduces the incidence of reetenosis.

Intracoronary brachytherapy for the treatment of recurrent drugeluting stent in-stent restenosis:A systematic review and metaanalysis

BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not available.We studied intracoronary brachytherapy(ICBT)and recurrent drug eluting stent in-stent restenosis(DES-ISR)to evaluate the procedural success,target lesion revascularization(TLR),incidence of myocardial infarction(MI)and all-cause mortality at 2 years follow-up.AIM To perform meta-analysis for patients undergoing ICBT for recurrent DES-ISR.METHODS We performed a systematic search of the PubMed/MEDLINE,Cochrane and DARE databases to identify relevant articles.Studies were excluded if intracoronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal stents.We used a random-effect model with DerSimonian&Laird method to calculate summary estimates.Heterogeneity was assessed using I2 statistics.RESULTS A total of 6 observational studies were included in the final analysis.Procedural angiographic success following intra-coronary brachytherapy was 99.8%.Incidence of MI at 1-year was 2%and 4.1%at 2-years,respectively.The incidence of TLR 14.1%at 1-year and 22.7%at 2-years,respectively.All-cause mortality at 1-and 2-year follow-up was 3%and 7.5%,respectively.CONCLUSION Given the observational nature of the studies included in the analysis,heterogeneity was significantly higher for outcomes.While there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES,this analysis suggests that brachytherapy might be the alternative approach for recurrent DES-ISR.Randomized controlled trials are required to confirm results from this study.

Comparison of the curative effect of intracoronary retrograde thrombolysis and thrombus aspiration combined with stent implantation on STEMI patients

Objective:To evaluate the short-term and long-term curative effects of precise intracoronary retrograde thrombolysis combined with stent implantation,thrombus aspiration combined with stent implantation,and traditional stent implantation in patients with acute ST-segment elevation myocardial infarction.Methods:From January 2018 to October 2019,184 patients diagnosed with acute ST-segment elevation myocardial infarction and infarction-related arterial blood flow TIMI 0 grade in the First Affiliated Hospital of Hainan Medical College and percutaneous coronary intervention(PCI)were selected.According to different surgical methods,patients were divided into intracoronary retrograde thrombolysis combined with stent implantation group(thrombolysis group,n=57 cases),thrombus aspiration combined with stent implantation group(aspiration group,n=57 cases)),traditional stent implantation group(traditional group,n=70 cases).Compare the incidence of no-reflow phenomenon after percutaneous coronary intervention,the rate of 1 hour ST_segment fall≥50%in the ECG after PCI,and the main adverse cardiovascular events(MACE)during hospitalization;compare the left ventricular end-diastolic diameter(LVEDD)、left ventricular ejection fraction(LVEF)and major adverse cardiovascular events at 1 year after PCI.Results:1.The short-term effects:The incidence of no-reflow phenomenon in the thrombolytic group was lower than that of the aspiration group and the traditional group,and the rate of 1hSTR≥50%was higher than that of the aspiration group and the traditional group,the difference was statistically significant(P<0.05).2.The long-term effects:1 year after percutaneous coronary intervention,the LVEDD of the thrombolytic group was lower than that of the aspiration group and the traditional group,while the LVEF was higher than the aspiration group and the traditional group,and the incidence of major adverse cardiovascular events in the thrombolytic group at was lowest,both the difference was statistically significant(P<0.05).Conclusion:The application of intracoronary retrograde thrombolysis combined with stent implantation in STEMI patients can reduce the occurrence of no-reflow,improve long-term cardiac function,and reduce the occurrence of major adverse cardiovascular events for short-term and long-term.

A CLINICAL ANALYSIS OF 24 PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PTCA AND INTRACORONARY STENT IMPLANTATION

The data of 24 cases(18men,6women) with AMI treated with directPTCA and intracoronary stant implantation were analyzed.The infart-related vessels were 13 LADs,4LCXs,7KCAs:The successful rate washigh(95.8%).The mean stenoses before and after performation were 95.6±5.4%,8.3±0.2%.18 stems were implanted in 16 cases.Lesscomplication happened during the procedure.There was a higher TIMI Ⅲflow patency rate in PTCA and intracoronary stent implantation than indrug thrombolysis (92% vs 40%).Stent implantation had a significanteffect on myocardial reperfution by enhancing the successful rate ofPTCA and reducing the stenosis significantly.

Intracoronary pressure gradient measurement in acute myocardial infarction patients with the no-reflow phenomenon during primary percutaneous coronary intervention

Background:Various experimental and clinical studies have reported on coronary microcirculatory dysfunction("no-reflow"phenomenon).Nevertheless,pathogenesis and effective treatment are yet to be fully elucidated.This study aimed to measure the intracoronary pressure gradient in the no-reflow artery during emergent percutaneous coronary intervention and explore the potential mechanism of no-reflow.Methods:From September 1st,2018 to June 30th,2019,intracoronary pressure in acute myocardial infarction patient was continuously measured by aspiration catheter from distal to proximal segment in the Department of Coronary Care Unit,Tianjin Chest Hospital,respectively in no-reflow arteries(no-reflow group)and arteries with thrombolysis in myocardial infarction-3 flow(control group).At least 12 cardiac cycles were consecutively recorded when the catheter was pulled back.The forward systolic pressure gradient was calculated as proximal systolic pressure minus distal systolic pressure.Comparison between groups was made using the Student t test,Mann-Whitney U-test or Chi-square test,as appropriate.Results:Intracoronary pressure in 33 no-reflow group and 26 in control group were measured.The intracoronary forward systolic pressure gradient was-1.3(-4.8,0.7)and 3.8(0.8,8.8)mmHg in no-reflow group and control group(Z=-3.989,P<0.001),respectively,while the forward diastolic pressure gradient was-1.0(-3.2,0)and 4.6(0,16.5)mmHg in respective groups(Z=-3.851,P<0.001).Moreover,the intracoronary forward pressure gradient showed significant difference between that before and after nicorandil medication(Z=-3.668,P<0.001 in systolic pressure gradient and Z=-3.530,P<0.001 in diastolic pressure gradient).Conclusions:No reflow during emergent coronary revascularization is significantly associated with local hemodynamic abnormalities in the coronary arteries.Intracoronary nicorandil administration at the distal segment of a coronary artery with an aspiration catheter could improve the microcirculatory dysfunction and resume normal coronary pressure gradient.Clinical trial registration:www.ClinicalTrials.gov(No.NCT 03600259).

Effects of Erigeron Injection on Vascular Endothelium in Patients after Intracoronary Stenting

Objective: To observe the levels of serum C-reactive protein (CRP), endothelin-1 (ET-1), nitric oxide (NO), and superoxide dismutase (SOD) in patients after intracoronary stenting (ICS), and the effects of Erigeron Injection (El) on them. Methods:Seventy-two patients, who received ICS and had symptoms of chest stuffiness, palpitation and chest pain, were randomly divided into two groups, with 36 patients in the control group treated with Plavix alone for anti-platelet aggregation, and the other 36 patients in the treated group treated with Plavix and El in combination. CRP, ET-1, NO and SOD were determined and compared before and 1, 2 and 3 weeks after treatment. Results: As compared with those in the control group, improvement of symptoms in the treated group was significantly better, with the levels of CRP and ET-1 lower and levels of SOD and NO higher or approaching to normal ranges and significant difference was shown between the two groups (P<0.01). Conclusion: El could alleviate uncomfortable feelings such as chest stuffiness in patients after ICS, and improve the function of vascular endothelium.

Assessment of angiographic coronary slow flow phenomenon with intracoronary ultrasound and doppler flow mapping

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Clinical benefits of intracoronary high-dose tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

To investigate the benefits of intracoronary high-dose tirofiban during primary percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI) .Methods Fifty-eight patients with STEMI presented within 12 h of symptoms were randomly allocated to study group (n = 28,intracor-onary high-dose tirofiban) and control group (n = 30,intravenous high-dose tirofiban) .The culprit vessels were targe-ted with primary PCI in all patients.Clinical characteristics,angiographic findings,brain natriuretic peptide (BNP) at 7-day and in-hospital outcomes were compared between groups,as well as left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACE,including death,reinfarction,worsening heart failure and target vessel revascu-larization) at 30-day clinical follow-up.Results Compared with the control group,the study group showed better thrombolysis in myocardial infarction (TIMI) flow grades immediately after PCI (96.4% vs 76.7% ,P = 0.02) .The 30-day composite major adverse cardiac events rate was lower in the study group (3.6% vs 23.3% ,P = 0.02) ,and the LVEF and BNP in the study group at 7 days was better than that in the control group (P = 0.01 and 0.02,respec-tively) .No significant difference in hemorrhagic complications in hospital between groups was noted (P = 0.61) .Conclusions The study indicates that intracoronary high-dose bolus administration of tirofiban for patients with STEMI who underwent primary PCI can significantly improve the reperfusion level in the infarct area and clinical outcomes at 30 days follow-up.It is better and safer to apply intravenous bolus injection for improving coronary flow,LVEF and short-term clinical outcomes.

Protective effect of intracoronary injection of anisodamine before myocardial reperfusion in acute inferior myocardial infarction patients undergoing primary PCI

Objective To investigate whether intracoronary administration of anisodamine before myocardial reperfusion could reduce/avoid no-reflow phenomenon and improve myocardial reperfusion in acute inferior myocardial infarction(AIMI)patients undergoing primary percutaneous coronary intervention(PCI).Methods In this single-center prospective randomized controlled study,we enrolled patients suffering from AIMI within 12 hours undergoing primary PCI from January 2014 to March 2016.Eligible patients were randomly divided into two groups:Anisodamine group,72 cases,intracoronary administration of anisodamine 1500 μg/3 ml before myocardial reperfusion;Control group,71 cases,intracoronary administration of saline 3 ml before myocardial reperfusion.All patients received transradial coronary intervention.Quantitative coronary angiography tissue perfusion indexes [including the initial thrombolysis in myocardial infarction(TIMI),postoperative TIMI,and TIMI myocardial perfusion grade(TMPG)]were judged by two interventional cardiologists.Myocardial infarct size was estimated by peak levels of CK-MB and cTnI.Inflammatory markers including hs-CRP,IL-6,P-selectin and ICAM-1 were tested before and 24 h after PCI.Electrocardiography was recorded on admission and at 90 min after PCI.A decrease in the sum of ST-segment elevation by≥70% was categorized as complete ST-segment resolution(STR)and used as an index of myocardial reperfu-sion and the primary end point of this study.Major ad-verse cardiovascular events were evaluated within 30 days and 6 months after discharge.Multivariate logistic regression analysis was used to explore the related factors associated with complete STR.Results After PCI,the proportions of TIMI 3(91.7% vs 77.5%,P=0.03)and TMPG 3(80.6% vs 60.6%,P=0.01)were significantly higher in anisodamine group than in control group.ST segments were significantly resolved,STE reduced from(10.0±4.2)mm to(5.8±1.7)mm in anisodamine group.The percentage of complete STR was statistically higher in anisodamine group than in control group(69.4% vs 50.7%,P=0.03).After PCI,there were 4 cases of bradycardia in anisodamine group and 42 cases bradycardia in control group.Multivariate Logistic regression analysis showed that low coronary diastolic pressure(OR=1.298,95% CI:1.155-1.457,P<0.01)and slow heart rate(OR=1.251,95% CI:1.087-1.440,P=0.002)were independent risk factors of incomplete STR,while anisodamine administration was a protective factor for complete STR(OR=0.059,95% CI:0.014-0.255,P<0.01).At 24 h after PCI,the levels of inflammatory markers increased in both two groups,but were significantly lower in anisodamine group compared to control group(P<0.01).Within 30-day after PCI,there was one patient developing new MI and another patient needing target vessel revascularization in control group.At the end of 6-month follow up,one MACE and 5 MACEs occurred in anisodamine group and control group respectively(P=0.21).Conclusion Intracoronary administration of anisodamine before reperfusion is safe and can reduce no-reflow and improve myocardial perfusion in AIMI patients undergoing PCI.

Relationship between maximal amplitude of thrombelastography and intracoronary thrombus in patients with acute coronary syndrome

Objective Thrombelastography(TEG)has been widely used for real-time monitoring of coagulation and bleeding systems.We want to investigate the relationship between intracoronary thrombotic lesion and TEG parameters in acute coronary syndrome(ACS)patients or guiding antithrombotic therapy.Methods A total of 328

Effect of intracoronary autologous bone marrow mononuclear cells transplantation on arrhythmia in canines

Objective To observe the survival and the differentiation of grafted bone marrow cells(BM-MNCs)in host myocardium.To observe whether BM-MNCs transplantation can potentially cause arrhythmia and whether the BM-MNCs transplantation can alter the spatial distribution of connexins,important mediator for arrhythmia gen-

Coronary thrombus in patients undergoing primary PCI for STEMI:Prognostic significance and management

Acute ST-elevation myocardial infarction(STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator,which is mostly proportional to their size and composition. Particularly,intracoronary thrombi impair both epicardial blood flow and myocardial perfusion,by occluding major coronary arteries and causing distal embolization,respectively. Thus,although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting,the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients,by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used inthe setting of STEMI to manage thrombotic lesions.

Non-invasive Assessment of Coronary Flow Velocity Reserve: A New Method Using Transthoracic Doppler Echocardiography

Summary: Transthoracic Doppler echocardiography (TTDE) allows noninvasive flow measurement in the distal left anterior descending artery (LAD). The feasibility of detecting coronary flow by contrast-enhanced TTDE with second harmonic technique was assessed, the coronary flow velocity reserve (CFVR) was evaluated in comparison to intracoronary Doppler flow (ICD) analysis and the CFVR after PTCA in LAD was investigated. In 77 (96 %) of 80 patients, CFVR was successfully determined with intravenous adenosine infusion. Doppler signal quality was evaluated in the first 46 patients by use of intravenous Levovist infusion and second harmonic technique. The Doppler flow was not visible in 1 patient only. CFVR determined from TTDE (2.77±0.65) was correlated closely with those from ICD (2.88±0.78) measurements (y=0.73x+0.67, r=0.87, P<0.001). In conclusion, TTDE is a feasible method and provides reliable data on CFVR which can be used for follow-up after PTCA.

Imaging Beyond the Angiogram in Women with Suspected Myocardial Infarction and No Obstructive Coronary Artery Disease

A subset of women referred to the cardiac catheterization lab for suspected myocardial infarction thought to be due to a culprit artery are found to have no obstructive coronary artery disease by angiography.The mechanism by which these women have myocardial injury varies and is not usually clear by history and angiography alone.Additional imaging,including modalities such as cardiac MRI,intravascular imaging,and computed tomography may be helpful to clarify diagnoses and direct treatment.

Drug dispersion for single- and multi-lumen catheters

This study presents a comparison of the drug dispersion capability of various catheters which can be used to inject medication or stem cells into the arterial system. The study was carried out by the use of numerical simulation so that various geometric and physical operating parameters could be investigated. The blood was modeled with a power-law viscosity and the medication had two levels of viscosity to represent upper and lower bounds expected in practice. Two different medication flowrates were also incorporated into the study. Finally, the impact of an inflated balloon up-stream of the injection was studied. The artery was simply modeled as a straight circular tube with the catheters concentrically positioned. It was found that in some cases, dispersion was improved by use of a multi-lumen device, particularly when an upstream balloon was employed to regulate blood flow and drug residence time. In other cases, the dispersion from the single-lumen device was superior. Another finding was that the multi-lumen device had a reduced hydraulic resistance to blood flow, compared to the single-lumen device when an upstream balloon was inflated.

Acute Pulmonary Embolism, Multiple Coronary Thrombosis, and Thrombi in the Left Ventricle and Ascending Aorta in a Patient with COVID-19 Infection

Both arterial and venous thromboembolic events are common in patients hospitalized in intensive care units with severe COVID-19. These patients often have laboratory findings consistent with a hypercoagulable state, suggesting widespread thrombosis and fibrinolysis, as well as elevated levels of D-dimer, von Willebrand factor (VWF), and factor VIII. There is increasing evidence that these thromboembolic events are associated with worse outcomes. We present the case of a 61-year-old man admitted for bilateral pneumonia due to COVID-19 infection, who developed during his hospitalization;Bilateral pulmonary thromboembolism, an acute myocardial infarction due to multiple coronary thrombosis, an intracavitary thrombus and thrombus in the ascending aorta. The patient was treated with systemic fibrinolysis and full doses of anticoagulation for pulmonary embolism, an emergency primary percutaneous coronary intervention (PCI) was performed with the implant of a drug eluting stent (DES) in the left anterior descending artery (LAD). Triple therapy with aspirin, clopidogrel and heparin was maintained until discharge. After the patient discharge, aspirin was stopped and treatment with clopidogrel and dabigatran was maintained for three months. In a subsequent outpatient control, the thrombi of the left ventricle and the ascending aorta resolved.