{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T13:45:38Z","timestamp":1774014338446,"version":"3.50.1"},"reference-count":14,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Polycythemia vera is a myeloproliferative neoplasm associated with a high thrombotic risk. Although this association is well recognized, acute coronary syndrome as the initial manifestation of polycythemia vera is rare. Case Presentation: We report the case of a previously healthy 57-year-old male with no conventional 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 testing showed markedly elevated hemoglobin (209 g\/L) and hematocrit (64.9%), together with thrombocytosis (438 \u00d7 109\/L). In the absence of conventional risk factors, the combination of a single-vessel coronary lesion and marked hematologic abnormalities raised suspicion for polycythemia vera as a major contributor to coronary thrombosis. Subsequent work-up confirmed polycythemia vera based on the presence of a JAK2 V617F mutation and suppressed erythropoietin levels. The patient underwent therapeutic phlebotomy shortly after angioplasty and was subsequently started on hydroxyurea to maintain a hematocrit below 45%, together with dual antiplatelet therapy. Conclusions: This case highlights acute myocardial infarction as a rare initial presentation of polycythemia vera. It underscores the importance of considering polycythemia vera in patients presenting with acute coronary syndrome and unexplained erythrocytosis, while acknowledging that, in the absence of intracoronary imaging, a definitive causal link between PV and the coronary event cannot be established.<\/jats:p>","DOI":"10.3390\/reports9010091","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T10:49:58Z","timestamp":1774003798000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Polycythemia Vera Revealed by Acute Myocardial Infarction: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5927-9750","authenticated-orcid":false,"given":"J\u00e9ni","family":"Quintal","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital S\u00e3o Bernardo, Unidade Local de Sa\u00fade da Arr\u00e1bida, Rua Camilo Castelo Branco 175, 2910-549 Set\u00fabal, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3513-6346","authenticated-orcid":false,"given":"Raquel","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Egas Moniz, Unidade Local de Sa\u00fade Lisboa Ocidental,  Rua da Junqueira 126, 1349-019 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatiana","family":"Duarte","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital S\u00e3o Bernardo, Unidade Local de Sa\u00fade da Arr\u00e1bida, Rua Camilo Castelo Branco 175, 2910-549 Set\u00fabal, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Santo","family":"Ant\u00f3nio","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology, Hospital S\u00e3o Bernardo, Unidade Local de Sa\u00fade da Arr\u00e1bida, Rua Camilo Castelo Branco 175, 2910-549 Set\u00fabal, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filipe","family":"Seixo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital S\u00e3o Bernardo, Unidade Local de Sa\u00fade da Arr\u00e1bida, Rua Camilo Castelo Branco 175, 2910-549 Set\u00fabal, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"405","DOI":"10.6004\/jadpro.2023.14.5.5","article-title":"Polycythemia vera: Thinking beyond the hematocrit","volume":"14","author":"Waggoner","year":"2023","journal-title":"J. Adv. Pract. Oncol."},{"key":"ref_2","first-page":"680","article-title":"Polycythemia vera: Rapid evidence review","volume":"103","author":"Fox","year":"2021","journal-title":"Am. Fam. Physician"},{"key":"ref_3","first-page":"848","article-title":"New guidelines from the NCCN for polycythemia vera","volume":"15","author":"Mesa","year":"2017","journal-title":"Clin. Adv. Hematol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1002\/ajh.27002","article-title":"Polycythemia vera: 2024 update on diagnosis, risk-stratification, and management","volume":"98","author":"Tefferi","year":"2023","journal-title":"Am. J. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1056\/NEJMoa1208500","article-title":"Cardiovascular events and intensity of treatment in polycythemia vera","volume":"368","author":"Marchioli","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1038\/s41408-017-0035-6","article-title":"Risk factors for arterial versus venous thrombosis in polycythemia vera: A single center experience in 587 patients","volume":"7","author":"Cerquozzi","year":"2017","journal-title":"Blood Cancer J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.blre.2014.12.002","article-title":"Mechanisms of thrombogenesis in polycythemia vera","volume":"29","author":"Kroll","year":"2015","journal-title":"Blood Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"eaan8292","DOI":"10.1126\/scitranslmed.aan8292","article-title":"Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms","volume":"10","author":"Wolach","year":"2018","journal-title":"Sci. Transl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1182\/blood-2006-08-042515","article-title":"Leukocytosis as a major thrombotic risk factor in patients with polycythemia vera","volume":"109","author":"Landolfi","year":"2007","journal-title":"Blood"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"571","DOI":"10.4330\/wjc.v15.i11.571","article-title":"Acute myocardial infarction in myeloproliferative neoplasms","volume":"15","author":"Manan","year":"2023","journal-title":"World J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.36660\/abc.20190104","article-title":"Acute myocardial infarction as first onset of polycythemia vera","volume":"114","author":"Silveira","year":"2020","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.repc.2018.09.014","article-title":"A rare cause of acute coronary syndromes in young adults\u2014Myeloproliferative neoplasms: A case series","volume":"38","author":"Cengiz","year":"2019","journal-title":"Rev. Port. Cardiol."},{"key":"ref_13","first-page":"111","article-title":"Acute myocardial infarction following sequential multi-vessel occlusion in a case of polycythemia vera","volume":"20","author":"Okabe","year":"2019","journal-title":"J. Cardiol. Cases"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1038\/s41408-018-0054-y","article-title":"The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: Document summary and in-depth discussion","volume":"8","author":"Barbui","year":"2018","journal-title":"Blood Cancer J."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/91\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T11:15:39Z","timestamp":1774005339000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["reports9010091"],"URL":"https:\/\/doi.org\/10.3390\/reports9010091","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}