In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.

在2019年冠状病毒疾病（COVID-19）大流行的时代，已在8％-62％的COVID-19感染患者中观察到急性心肌损伤（ACI），心肌肌钙蛋白升高至99％以上严重感染患者中发生率和死亡率最高。除了临床上和心电图上可识别的ACI原因（例如急性心肌梗塞（MI））外，还需要考虑其他心脏原因，例如心肌炎，Takotsubo综合征和COVID-19直接损伤，以及非心脏疾病，例如肺部疾病栓塞，严重疾病和败血症。与大流行前时期相比，大流行期间COVID-19阳性和阴性患者中具有正常或接近正常冠状动脉（ACS-NNOCA）的急性冠状动脉综合征（ACS）的患病率更高。超声心动图，冠状动脉造影，胸部计算机断层扫描和/或心脏磁共振成像可提供正确的诊断，从而无需进行心内膜活检。重要的是，已记录了ACS患者寻求症状咨询的显着延迟，而在ST抬高型MI（STEMI）情况下，由于较少的紧急冠状动脉造影和/或主要的经皮冠状动脉介入治疗，其常规护理已被严重中断。并向溶栓治疗转移不当，所有这些因素都会导致较高的并发症发生率。因此，在大流行时期，在对ACI / ACS患者进行诊断和提供治疗方面出现了新的挑战。本文对这些问题，ACI / ACS开发中涉及的各种机制以及相关的当前指南进行了回顾。