Since the pandemic’s beginning, the disease caused by the SARS-CoV-2 virus, called COVID-19, has shown itself to be a wide-spectrum and unpredictable condition, with patients being practically asymptomatic. In contrast, others had severe pulmonary involvement, the major cause of morbidity and mortality associated with the disease. ^–

At an early stage, COVID-19 was shown to have a broad and potentially alarming link to the cardiovascular system. Angiotensin-2-converting enzyme receptors have been shown to directly interface with viral pathogenesis and maybe the cellular gateway for type 2 pneumocytes, macrophages and cardiomyocytes. Thus, patients with cardiovascular diseases were more susceptible to severe forms of the disease. Hypertension, arrhythmias, cardiomyopathies and coronary artery disease were among the main comorbidities in critically ill patients with COVID-19. Patients with cardiovascular diseases (particularly those with hypertension) have a morbidity rate of up to 10.5% after infection with COVID-19. In the present study, we can observe a similar relationship. It was clear in this Brazilian series how the presence of atherosclerotic disease and traditional risk factors alone or together were capable of impacting mortality and prognosis. Although the study has a limited series, it includes only high-risk patients with a high rate of outcomes, allowing the evaluation of results to be consistent and following exactly the same line as the international literature.

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Diseases of the circulatory system predominate as the leading cause of death in the world; among cardiovascular diseases, ischemic heart diseases are the first group of causes. Ischemic heart disease (IHD) is the leading global cause of death, accounting for more than 9 million deaths in 2016, according to estimates from the World Health Organization (WHO). Mortality from IHD in Western countries has decreased dramatically over the past few decades, with a greater focus on primary prevention and better diagnosis and treatment of IHD. However, developing countries present new challenges for public health — this scenario is reproduced in Latin America. In this study, carried out in Colombia, the mortality rate from IHD was 150 deaths per 100,000 inhabitants in 2015, representing the main cause of deaths in that country.

Developing scores capable of predicting death from the diseases responsible for the largest share of deaths in the world has always been among the objectives of cardiologists. The question “How likely is this patient with acute IHD to die?” is made, whether consciously or not, every time there is a diagnostic possibility of acute myocardial infarction (AMI) with or without ST-segment elevation or unstable angina.

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