Background: The demographics, angiographic findings, and in-hospital outcomes of coronavirus disease-2019 (COVID-19) – positive patients undergoing an invasive strategy for suspected acute coronary syndromes (ACS) are not well defined COVID-19–positive ACS patients may have different etiology and outcomes Patient presentation times from small sample published data appear longer Methods: Anonymized data on 234 patients in 81 global centers are presented from this prospective registry for the period March 1, 2020, to May 31, 2020 As of submission date, a further 84 patients have been submitted All were required to be COVID-19–positive (or have a high index of clinical suspicion, i e , clinical status plus chest x ray/computed tomography scan findings) and to undergo coronary angiography for suspected ACS Results: Results are shown in Tables 1–3 and compared with National United Kingdom British Cardiovascular Intervention Society/Myocardial Ischaemia National Audit Project databases of non–COVID-19 ACS patients where available and appropriate Major findings were: significantly higher proportion of COVID-19–positive patients had hypertension, hyperlipidemia, and renal dysfunction In the ST-segment elevation myocardial infarction (STEMI) subgroup, symptom-to-door time was >double and door-to-balloon increased by median 20 minutes Mortality was quadruple and in-patient stay double in this group Similarly, mortality was significantly higher in non-STEMI COVID-19–positive cohort and in-patient stay also double The high mortality may be due to the high incidence of cardiogenic shock (13 4% vs 5%), with its 67% mortality [Formula presented] Conclusion: These novel data indicate that COVID-19–positive ACS patients present later, have higher incidence of cardiogenic shock, and much higher mortality, which are likely to be inter-related In-patient stay is prolonged compared to non–COVID-19 ACS Categories: CORONARY: Acute Coronary Syndromes