STEMI in Times of Crisis: Comparative Analysis During Pandemic and War

<b>Background:</b> Crises such as pandemics and wars significantly impact cardiovascular health, particularly ST-Elevation Myocardial Infarction (STEMI). The COVID-19 pandemic led to overwhelmed healthcare systems and delayed care, while the October 2023 war in Israel posed unique challenges, including altered patient behavior and access to care. This study compares STEMI outcomes during these two crisis periods, focusing on mortality and care pathways. <b>Methods:</b> This retrospective cohort study, conducted at Soroka University Medical Center, analyzed patients with STEMI during the COVID-19 lockdown (14 March 2020-14 June 2020), the war period (07 October 2023-7 January 2024), and quiet periods in 2022. Patient demographics, arrival methods, and outcomes were compared. Multivariable logistic regression identified mortality predictors. <b>Results:</b> Among 397 patients with STEMI, 30-day mortality was 7.5 times higher during COVID-19 (OR 7.50, <i>p</i> = 0.038), and in-hospital mortality was 10.25 times higher (OR 10.25, <i>p</i> = 0.046) compared to the war. The war period showed an 86% reduction in 30-day mortality (OR 0.14, <i>p</i> = 0.026). More patients arrived by ambulance during COVID-19, while during the war, more were referred via emergency medical centers and admitted directly to the ICCU. <b>Conclusions:</b> The COVID-19 pandemic significantly increased STEMI mortality, while the war's coordinated care pathways improved outcomes. Tailored crisis management strategies are important to ensure effective acute care during pandemics and conflicts.