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Background: The coronavirus disease-2019 (COVID-19) has profoundly disrupted health care services both by a massive influx of critical COVID-19 patients and through indirect effects, including medical care avoidance behaviors and the decreased efficiency of existing pathways of care Methods: We conducted a multinational retrospective survey analyzing the overall volume and the delays in presentation of acute coronary syndromes (ACS) and ischemic strokes during the COVID-19 pandemic (January 1, 2020, to April 30, 2020), comparing historical controls (same period in 2019) Eight centers in 4 countries contributed to the survey: Russia (4), Brazil (2), Kindgom of Saudia Arabia (1), and Tunisia (1) Results: While the ACS volume tended to increase in January and February 2020 in comparison to the same period in 2019, in March and April 2020 the number of ST-segment elevation myocardial infarction (STEMI) decreased by 17 6% and 39 2%, respectively, as well as the number of non-NSTEMI (by 9 6% and 26 4%, respectively) in comparison with March and April 2019 A gradual decrease in stroke cases along the first trimester was found (January -1 6%, February -3 1%, March -5 8%) when comparing 2020 to 2019, followed by 3 5% increase in April 2020 in comparison to March 2020 Early STEMI presentation (≤2 h) was less often encountered in the first quadrimester of 2020 in comparison with the first quadrimester of 2019 (36 2% vs 23 3%;p < 0 001) Conversely, the delays of ischemic strokes were similar between the 2 periods [Formula presented] Conclusion: The number of ACS patients requiring invasive approach decreased in March and April 2020 whereas no significant change in ischemic stroke volume was found along the first quadrimester of 2020 in comparison with the same period of 2019 Categories: CORONARY: Acute Coronary Syndromes