Alquézar-Arbé, AitorMiró, ÒscarCastillo, Juan González DelJiménez, SòniaLlorens, PereMartín, AlfonsoMartín-Sánchez, Francisco JavierGarcía-Lamberechts, Eric JorgePiñera, PascualJacob, JavierPorrino, Juan Miguel MarínJiménez, BlasRío, Rigoberto DelGarcía, Carles PérezAznar, José Vicente BrasóPonce, María CarmenFernández, Elena DíazTost, JosepMojarro, Enrique MartínGarcía, Arturo HuertaQuirós, Alejandro MartínNoceda, JoséCano, María José CanoAlmela, Amparo Fernández de SimónBayarri, María José FortunyTejera, Matilde GonzálezRodriguez, Alberto DomínguezBurillo-Putze, GuillermoSpanish Investigators on Emergency Situations TeAm (SIESTA) Network2023-05-032023-05-032021-11-03http://hdl.handle.net/10668/22302There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses. We investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department. We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes. We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21-1.78%]). This incidence was lower than that observed in non-COVID-19 patients (3.64% [95% CI 3.54-3.74%]; odds ratio [OR] 0.40 [95% CI 0.33-0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in 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 comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4). The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.enCOVID-19SARS-Cov-2acute coronary syndromeclinical characteristicsincidenceoutcomerisk factorsAcute Coronary SyndromeCOVID-19Emergency Service, HospitalHumansIncidenceMiddle AgedRetrospective StudiesRisk Factorsresearch article35065863open access10.1016/j.jemermed.2021.10.0460736-4679PMC8563352https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563352https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563352/pdf