There was a dearth of understanding regarding the true incidence of acute coronary syndrome (ACS) in COVID-19 patients, as well as their clinical features and prognoses. The incidence, clinical features, risk factors, and outcomes of ACS in COVID-19 patients in the emergency department were studied. Between March and April 2020, researchers analyzed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments (the first wave of COVID-19). They divided the patients into two groups: COVID-19 patients without ACS (control A) and non–COVID-19 patients with ACS (control B) (control B). Unadjusted comparisons of 58 characteristics and outcomes between cases and controls were made.

In 74,814 COVID-19 patients entering the ED, identified 110 with ACS (1.48% [95% confidence interval CI 1.21–1.78%]). This was lower than in non–COVID-19 individuals (3.64% [95% CI 3.54–3.74%]; odds ratio [OR] 0.40 [95% CI 0.33–0.49]). Previous coronary artery disease, age ≥60 years, hypertension, chest discomfort, elevated troponin, and hypoxemia were the clinical features of COVID-19 patients that were related to a greater likelihood of presenting ACS. Cases had a greater requirement for hospitalization, admission to critical care, and in-hospital mortality than control group A (adjusted OR [aOR] 6.36 [95% CI 1.84–22.1], aOR 4.63 [95% CI 1.88–11.4], and aOR 2.46 [95% CI 1.15–5.25]). When patients were compared to control group B, the aOR for critical care admission was 0.41 (95% CI 0.21–0.80), while the aOR for in-hospital death was 5.94 (95% CI 2.84–12.4). The rate of ACS in COVID-19 patients who visited the emergency room was modest, about 1.48%, although it might rise in specific scenarios. Patients with COVID-19 and ACS exhibited a poorer prognosis and increased in-hospital mortality than control participants.