Abstract
A 40-year-old male, with no cardiac risk factors, presented with sudden onset, severe, central chest pain 7 days after receiving the first Oxford-Astra Zeneca SARS-CoV-2 vaccine dose. This was associated with anterior ST-segment elevation on electrocardiogram (Panel A), marked troponin elevation (peak 2726 ng/L; normal < 14ng/L), significant thrombocytopenia with a platelet count of 7 × 109/L, a D-dimer of 80 000µg/L (FEU) and anti-PF4 seropositivity. Echocardiography revealed akinesia of the mid-to-apical antero-septum and apex (ejection fraction ∼45%). Refractory thrombocytopenia precluded coronary angiography and primary angioplasty. Computed tomography coronary angiography demonstrated extensive layered thrombus from the ostium of the left anterior descending (LAD) artery with moderate proximal-LAD stenosis and complete mid-LAD occlusion (Panel B), suggesting the diagnosis of coronary thrombosis due to vaccine-induced immune thrombocytopenia and thrombosis (VITT). Plasmapheresis, intravenous immunoglobulins, methylprednisolone, and rituximab were successively administered to manage the VITT. The ST-elevation myocardial...
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