Polycythemia Vera Revealed by Acute Myocardial Infarction: A Case Report

Background: Polycythemia vera is a myeloproliferative neoplasm associated with a high risk of thrombosis. While well-documented, acute coronary syndromes as the initial manifestation of polycythemia vera are rare. Case Summary: We report the case of a previously healthy 57-year-old male with no cardiovascular risk factors who presented with an anterior ST-elevation myocardial infarction. Coronary angiography revealed a subocclusive lesion in the left anterior descending artery, which was successfully treated with primary percutaneous coronary intervention. Initial laboratory tests revealed elevated hemoglobin (209 g/L) and haematocrit (65%), along with thrombocytosis (438 x 109/L). The combination of a single-vessel coronary lesion in a patient without conventional risk factors and the presence of hematologic abnormalities raised suspicion for polycythemia vera. Subsequent investigation confirmed the diagnosis based on a positive JAK2 V617F mutation and suppressed erythropoietin levels. The patient was treated with therapeutic phlebotomy shortly after the angioplasty and later initiated hydroxyurea to maintain haematocrit < 45% in association with dual antiplatelet therapy. Conclusions: This case highlights a rare but critical presentation of acute myocardial infarction as the first clinical manifestation of polycythemia vera. It underscores the importance of considering polycythemia vera in the differential diagnosis for patients presenting with an acute coronary syndrome, especially in the absence of traditional cardiovascular risk factors. Early recognition and prompt therapeutic intervention are crucial to prevent future thrombotic events and improve patient prognosis.