ST-elevation myocardial infarction in a 39-year-old patient with “normal” coronary arteries as a thrombotic complication of COVID-19

We report the case of a 39-year-old male without traditional risk factors for coronary artery disease (CAD), i.e. smoking, hypercholesterolemia, hypertension, diabetes mellitus, familial history of premature CAD, admitted with anterior ST-segment elevation myocardial infarction and concurrent coronavirus disease-2019 infection. Coronary angiography showed high intracoronary thrombus burden and thrombotic occlusion of the proximal segment of left anterior descending artery, while optical coherence tomography revealed intact endothelium after thromboaspiration. <Learning objective: Coronavirus disease-2019 (COVID-19) may predispose to thrombotic complications in both the venous and the arterial circulation. ST-segment elevation myocardial infarction (STEMI), rarely, may be the main clinical presentation of COVID-19. STEMI in patients with concurrent COVID-19 may be caused by thrombotic coronary occlusion even in the setting of “normal” coronary arteries.