Highly inflamed coronary plaque detected by Angio-CT in a 28-year-old patient with STEMI and long COVID-19

Long COVID-19 syndrome increases the risk of cardiovascular events. Although rare in young people, acute coronary syndromes occur more often in those recently infected with COVID-19. This report discusses a rare case of myocardial infarction in a 28-year-old male with no prior medical issues, occurring four weeks after a mild COVID-19. Initially, the patient refused invasive coronary angiography, so a coronary computed tomography angiography (CCTA) was conducted during an ST-elevation myocardial infarction (STEMI). The CCTA, using fat attenuation index (FAI) technology, revealed significant inflammation at the culprit lesion. This CCTA and FAI analysis were done shortly after the STEMI onset, before revascularization, highlighting the case's uniqueness. In patients with recent COVID-19, CCTA combined with FAI analysis of perivascular inflammation can help identify those at risk for acute coronary events. In this case, FAI analysis detected high inflammation, suggesting a potential cause for STEMI in a young patient with long COVID-19.