A 56-year-old male, with 40-pack-year of smoking and dyslipidemia, presented to a district hospital after 6 hours of sudden chest pain. He was hemodynamically stable. ECG showed sinus rhythm with ST-segment elevation in inferior leads suggestive of inferior STEMI. Since there was no cardiac catherization facility nearby, he was given oral aspirin with clopidogrel and successfully thrombolysed with IV streptokinase. He was then referred to a cardiac centre for early coronary angiogram.
Repeat ECG at the cardiac centre showed sinus rhythm and complete resolution of ST-segment elevation with T-wave inversions in the inferior leads. Echocardiogram showed left ventricular ejection fraction of 50% with inferior and posterior wall hypokinesia.
This case demonstrated a persistent heavy intracoronary thrombus burden in a patient with recent inferior STEMI despite given IV streptokinase, dual oral antiplatelet therapy, IV glycoprotein IIb/IIIa inhibitor, subcutaneous low molecular weight heparin and multiple attempts of thrombus aspiration. Further intracoronary intervention was delayed to allow for longer duration of antithrombotic therapy with DAPT and direct oral anticoagulant (DOAC) till one month, which resulted in complete resolution of intracoronary thrombus and prevented angioplasty of a vessel without significant stenosis. However, further trials or evidence are needed for management of similar cases.