Treatment of left main coronary artery thrombus during SARS-CoV-2: early surgical revascularization is key

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause a hypercoagulable state leading to coronary artery thrombosis. The optimal management of this phenomenon has not been well elucidated. We describe a 38-year-old male who developed an ST-elevation myocardial infarction secondary to a left main coronary artery thrombus after SARS-CoV-2. The patient failed anticoagulation and fibrinolysis and developed decompensated heart failure. Ultimately, the patient underwent surgical revascularization, which led to full recovery. This highlights the need for refinement in this population. We recommend that early surgical intervention be considered in patients with ST-elevation myocardial infarction secondary to left main coronary artery thrombus in the setting of SARS-CoV-2.