question: OBJECTIVES: To determine if Victorian state of emergency (SOE) measures to combat COVID‐19 were associated with delayed presentations or management of acute stroke and acute myocardial infarction (AMI). METHODS: This was a retrospective, pre‐ and post‐implementation study using data from an adult, tertiary cardiology and neurosciences centre with 24‐hour capacity for endovascular procedures. All primary presentations with acute stroke or AMI during the first 28 days of Stage 2 and 3 SOE restrictions (26 March to 23 April 2020) were compared to an equivalent period without restrictions (26 March to 23 April 2019). The primary outcome variable was time from onset of symptoms to emergency department (ED) presentation. RESULTS: There were 52 (1.6% of all ED presentations) patients that met inclusion criteria during the SOE period and 57 (1.0%) patients in the comparator period. Patients were equally matched for demographics, disease severity and prior history of stroke or AMI. Median time from symptom onset to presentation was 227 (93‐1183) mins during the SOE period and 342 (119‐1220) mins during the comparator period (p=0.24). Among eligible patients with ischaemic stroke or ST‐elevation AMI, median time to primary reperfusion intervention was 65 (37‐78) mins during SOE and 44 (39‐60) mins in the comparator period (p=0.54). There were no differences in mortality at hospital discharge (9.6% vs 10.5%) and hospital LOS (5.4 vs 4.3 days). CONCLUSIONS: In the first 28 days, SOE measures to combat COVID‐19 were not associated with delays in presentation or life‐saving interventions for patients with acute stroke and AMI. This article is protected by copyright. All rights reserved.