Assessment of the risk of in-hospital fatality in patients with acute coronary syndrome and SARS-CoV-2 infection: challenges and prospects

   An acute coronary event in the presence of SARS-CoV-2 infection has its own characteristics that affect the course of the disease and the choice of treatment methods. Due to the lack of data on this category of patients, it is necessary to look for ways to determine the risk of adverse outcomes of this condition, including the difficulties of risk stratification.   Aim: assessment of clinical and laboratory parameters and features of the clinical course in patients with ACS in combination with SARS-CoV-2 infection at the hospital stage. Construction of a prognostic model for the risk of death.   Materials and methods. The study included 225 patients admitted to the regional vascular center with a diagnosis of ACS and a verified diagnosis of SARS-CoV-2 infection. Initially, 120 general clinical, biochemical and instrumental parameters were assessed. The second stage involved analysis of plasma metabolites in 73 patients.   Results. A predictive model was constructed highlighting the eight most significant variables that correlate with in-hospital mortality in patients with ACS in combination with SARS-CoV-2: age, the presence of atrial fibrillation (except for that first detected in ACS), acute kidney injury, CKD above stage 2, severe and extremely severe course of SARS-CoV-2 infection, levels of ferritin, albumin and glycemia in the blood serum upon admission to the hospital. The present study identified new markers of mortality risk, such as C18 ceramide (d18:1/22:0) and ceramide (d18:1/24:0) levels.   Conclusions. The proposed approach to assessing the risk of nosocomial death in acute coronary syndrome in combination with SARS-CoV-2 infection has good prognostic accuracy and is easy to use.