Cardiovascular complications are frequent in SARS-CoV-2 patients. The characteristics of acute coronary syndromes (ACS) in this population have not yet been reported.

We aimed to report clinical characteristics and outcome of patients with and without SARS-CoV-2 infection referred for acute coronary syndrome (ACS) during the peak of the pandemic in France.

We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or NSTEMI during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south and north of France), all performing primary percutaneous coronary intervention (PCI).

The study included 237 patients (67±14, 69% of male), 111 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2 associated ACS was 11% (n=26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen >6L/min). Patients were comparable regarding medical history and risk factors, except higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs. 25.5%, P=0.003). In SARS-CoV-2 patients, admission for cardiac arrest was more frequent (26.9% vs. 6.6%, P<0.001), and significant coronary artery disease and culprit artery occlusion were reported in 76.5% and 92% of STEMI patients, and 88.9% and 50% of NSTEMI, respectively. PCI was performed in the same percentage of STEMI (82%) and NSTEMI (86%) cases, regardless of SARS-CoV-2 infection, but no-reflow after PCI (19.2% vs. 3.3%, P<0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared to non-infected patients (26.9% vs. 6.2%, P<0.001)

SARS-CoV-2 infection is frequent in ACS patients with higher incidence of coronary occlusion and no-reflow compared to non-SARS-CoV-2 ACS, which may explain the higher in-hospital mortality, despite a similar rate of PCI.