IJCS | Volume 33, Nº4, July and August 2020

432 Discussion Case 1 refers to an elderly patient with STEMI treated with the usual and recommended management of this clinical presentation. Despite no flu-like symptoms at admission and denial of contact with people who tested positive or are suspected to have Covid-19, the patient developed pneumonia caused by SARS-CoV-2 with a fatal endpoint. The wide incubation period (4-14 days) does not allow us to determine whether contamination occurred prior to admission or during hospital stay, but the presence of fever from the first days (<72 hours) suggests community infection. Zhou et al., 4 reported the clinical worsening that occurs in the second week after the onset of symptoms in advanced age and among severe comorbidity subgroups. Such clinical deterioration is caused not only by pulmonary parenchyma injury but also by thromboembolic phenomena. There is a positive correlation between elevated fibrinogen and D-dimer levels and in-hospital death in COVID-19 patients, which emphasizes the characteristic of a prothrombotic state 11 and may have contributed to the unfavorable evolution of the reported patient. Another important issue to be discussed is the complete revascularization strategy in multivessel patients with STEMI, especially at the moment of a pandemic. The institution current practice is based on recent data published in the literature, 12 with complete revascularization performed during the same hospital stay, usually48-72hours after the indexprocedure. There were two other possibilities in this scenario: 1) complete revascularization in the index procedure, aimed at shortening hospital length of stay and exposure to SARS-CoV-2, but with a higher contrast load; 2) to treat the culprit lesion and postpone the second procedure Figure 3 – Chest Computed Tomography with bilateral interstitial ground/glass infiltrate. Esteves et al. Covid-19 and STEMI Int J Cardiovasc Sci. 2020; 33(4):429-435 Case Report