The COVID-19 pandemic has significantly impacted the Tunisian healthcare system. To reduce the risk of contracting or transmitting COVID-19, the Centers for Disease Control and Prevention recommended deferral of elective cardiac procedures, including coronary angiography (CA) and percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD).

However anecdotal reports suggest also a decline in the number of patients consulting for an unstable CAD and therefore in the activity of the catheterization laboratory.

To confirm this finding, we conducted a study comparing the number of patients who consulted for an unstable CAD and who benefited from a CA associated or not with a PCI during the confinement period (CP) (from March 15, 2020 to April 30, 2020) and just 6 weeks before (from February 1, 2020 to March 15, 2020) in Mongi Slim La Marsa University Hospital Center.

Our analysis showed that out of 183 patients with unstable CAD, 127 (69,4%) and 56 (30.6%) consulted and were urgently treated in our catheterization laboratory respectively before and during the confinement period thus an estimated 40% reduction in our daily activity (Fig. 1).

Potential etiologies for the decrease in unstable patients with CAD may be related to the avoidance of medical care due to social distancing or concerns of contracting COVID-19 in the hospital and ST-Segment elevation myocardial infarction misdiagnosis. As long as the pandemic continues, we highly recommend to follow this signal and investigate its causes.