The development of acute coronary syndrome (ACS) is caused by an acute discrepancy between the myocardial oxygen demand and its delivery. This mechanism is more associated with the progression of coronary atherosclerosis in combination with an inflammatory response, hypoxemia, procoagulant state of blood plasma and platelets. Patients with the new coronavirus infection COVID-19 (COronaVIrus Disease 2019), burdened by cardiovascular diseases and comorbid pathology, represent a high risk group for ACS. The purpose of study: To analyze the published literature, which reflects data on the development of ACS in patients with COVID-19, its pathogenesis, and features of the clinical course? Material and methods. The search for literary data was carried out using Google Scholar, PubMed, ScienceDirect and Cyberleninka services. The analysis included data from clinical guidelines for the management of patients with COVID-19, data from clinical trials, reports and systematic reviews. Results. This literature review summarizes and systematizes the data presented in modern scientific publications, highlights aspects of the clinical course and features of the pathogenetic mechanisms underlying ACS in patients with COVID-19. Conclusion. The pathogenesis of COVID-19 is inextricably linked with the widespread cytopathic effect of SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2, coronavirus 2, causing severe acute respiratory distress syndrome), the generation of a pathological uncontrolled immune response that causes systemic inflammation, as well as the implementation of procoagulant activation of the hemostasis system. In patients with COVID-19, along with the atherosclerotic process, these mechanisms significantly increase the risk of developing ACS and may worsen its course at the hospital stage.