Acute coronary syndromes (ACS), and in particular acute ST-segment elevation myocardial infarction, have a high rate of complications and associated mortality.1,2 Early access to percutaneous coronary intervention (PCI) has significant prognostic implications and is currently recommended in society guidelines worldwide.

In response to the SARS-CoV-2/COVID-19 pandemic, healthcare institutions have organized their facilities to guarantee timely access to coronary angiography and PCI for ACS patients. However, the number of reported ACS admissions during the lockdown decreased.3 This is of particular interest, given the positive association between ACS and viral disease seasonality,4 and also due to recent evidence showing increased thrombogenicity in COVID-19 patients.5

A recent report from 71 Spanish centers showed reductions in interventional cardiology activity, including a 40% reduction in PCI in ST elevation myocardial infarction.6 Importantly, Portuguese nationwide data analysis has systematically shown relative excess in mortality given the number of positive COVID-19 cases. A possible explanation could be related to an increase in the number of untreated ACS patients who did not seek medical care or call the emergency hotline during the lockdown.

We performed descriptive ACS-related data analysis at Hospital Professor Doutor Fernando Fonseca, which has an area of influence including approximately 600 000 patients. In the first 30 days after the lockdown in Portugal, the number of ACS admitted to our hospital, and who underwent a coronary angiography (n=30), was reduced by 49.7% compared with the mean between 2016-2018 over the same time period (n=60.3).

Given the global nature of the current situation, we hypothesize that similar findings will be found at other Portuguese centers. Going forward, the Portuguese Society of Cardiology, the Portuguese Association of Cardiovascular Interventions and the Stent - Save a Life Initiative, alongside health authorities and media should publicly promote that patients with ACS-compatible symptoms should avoid confinement and seek urgent medical attention.